


The Broken Tether

by J_Baillier



Category: Sherlock (TV), Sherlock Holmes & Related Fandoms
Genre: 2nd person POV, Acute stress disorder, All the medical and angsty bells and whistles you should expect from a J. Baillier story, Angst, Autism Spectrum, Don't copy to another site, Drama, Friends to Lovers, Heart valve replacement, Hurt/Comfort, M/M, Medical Procedures, Medical Realism, Medical Trauma, Mrs Hudson's herbal soothers, POV John Watson, PTSD, Romance, although they were sort of both right from the start even if nobody says it out loud, open heart surgery
Language: English
Status: Completed
Published: 2020-10-25
Updated: 2020-12-03
Packaged: 2021-03-09 07:16:06
Rating: Mature
Warnings: No Archive Warnings Apply
Chapters: 15
Words: 54,329
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/27189907
Author URL: https://archiveofourown.org/users/J_Baillier/pseuds/J_Baillier
Summary: Maybe he thinks that you only enjoy his company because of the Work, because of the way his dazzling intellect shines when he's in his element, but the truth is this: it is when he is at his most human, most bare, that you feel closest to him.
Relationships: Mycroft Holmes & Sherlock Holmes, Sherlock Holmes/John Watson
Comments: 785
Kudos: 464
Collections: Sherlock Author Showcase 2020





	1. Left Breathless

**Author's Note:**

> [[an index and guide to all my Sherlock stories](https://archiveofourown.org/works/25011148)]
> 
> This story crept up on me while trying to work out which of my current WIP drafts I should be tackling. This fic was a needed break from those and a vital injection of enthusiasm. It got me back on my proverbial writing horse because it had been some time since I had enjoyed drafting a fic so much that I didn't want to stop! 
> 
> The genre of this story is very much what my regular readers should have learned to expect from my best-known solo endeavours such as _The Breaking Wheel_ , but there is one major new experiment contained herein: the use of the rare and challenging second person POV. In other words: welcome to the brain of an army doctor. John's got some fancy vocabulary which I have provided explanations for in the author's notes of each chapter. I guarantee you will know a lot more about how the human heart functions (at least physically) after reading this!
> 
> While none of the really heavy content warnings apply to this story, I should probably mention that there is high level of medical realism here pertaining to intensive care and open heart surgery and the emotional sequelae of sudden, critical illness.

Edward Marston, arsonist extraordinaire, is a rare breed of criminal in that he's really given Sherlock a run for his money. Fifteen locations in Greater London have gone up in flames, the fires triggers remotely by activating inventive remote devices which had prompted a rare admission of being impressed from Sherlock. As usual, that had been frowned upon by the Met team, even though Sherlock's level of enthusiasm and engagement reversely correlates to how long it takes for him to solve a case.

You refuse to be impressed by someone who thinks endangering people's lives and destroying their property is fun, even if they put a lot of thought into it.

The thing about Marston is that he can resist the urge to stay and watch the flames go up, which seems to go against every constant known about his type of criminal minds. When Lestrade had pointed this out, Sherlock had scoffed and said that, for this particular culprit, the gratification is cerebral: achieving the technical feat without getting caught. Sherlock has described Marston as an artist, not someone who feels compelled to — direct quote from the world's only consulting detective — _'masturbate to the sight of a burning skip_ '. That was among many of his statements which had raised some eyebrows, and you had chuckled not-even-that-secretly. They should be all used to the terrible, terrible, humour between you and Sherlock by now. You love those oddly private moments with Sherlock amid a crowd — it's you against them, _us against the rest of the world_. In those moments, he takes the time to direct his words and his attention at you and only you, drinking in your response. In those moments, you feel as luminous as he is, bask in the warmth of his intellect, and it's almost a physical jolt when he slips his work persona back on, hardens the angles of his features and gets back to the business at hand. You almost miss him then, though he's right there.

As the case progresses, you feel that familiar, tinglingly exciting tension of getting closer and closer, a sense of a predator circling their prey as Sherlock's deductions close doors to investigative cul-de-sacs and open new ones towards revelation. Finally, _finally_ you catch sight of the suspect who has taken the bait after being taunted by Sherlock on national television as part of a plan devised with the Met to smoke him out. Marston is everything you expected: young, arrogant, educated — just the sort that Sherlock enjoys playing games with. For him, catching disorganised, unintelligent, brutish offenders is like shooting fish in a barrel since they're more predictable and not very creative.

Arsonist Edward Marston is also _fast_. Thankfully, Sherlock is fast, too. He never purposefully seems to exercise, his diet is appalling, and he smokes sporadically but heavily. Yet somehow he looks like an Olympic athlete darting after London's foulest, as case after case inevitably leads to chases and arrests. He is fast, and he is formidable — a sight to behold as he vaults over things like a parkour professional.

Except… not today. Rounding a corner, expecting to have lost sight of both him and the suspect, it surprises you to find Sherlock leaning against a portico, breathing so hard he's gasping. He raises his head just a fraction when you call out his name, and he gestures you to continue pursuing Marston, too winded to speak.

"Are you o–––"

He flaps his hand like an irate eagle. " _Go!_ " he rasps.

You curse and launch back into a sprint. You're winded, too, since this pursuit has been going on for a while. Sherlock had probably just tried to find a shortcut and climbed over something which had temporarily exhausted him, so you're not really worried. Not really surprised. He just got too out-of-breath from over-exerting himself. That's what you tell yourself and focus on finding Marston.

Minutes later, you're sitting on the man's shoulders on the spot where your tackle had made a softish landing on a pile of leaves left behind by Hyde Park gardeners. Lestrade's in the first panda on site and gets to do the honours with the cuffs. You pat your trousers clean of colourful maple leaves and grin like the madman you've left behind to catch his breath.

Any second now, Sherlock going to stride in and collect his prize of getting to face who he's been chasing. It's the moment of seeing the minotaur at the centre of the labyrinth, and you know Sherlock cares more about that than getting to tackle someone into a pile of wet maple leaves.

As you wait, you watch Marston as he glares at the Met officers, most of all Lestrade who's reading him his rights. The man in cuffs doesn't look _that_ impressive, really. They never do, not to you. Especially not the serial killers. Their visible humanity as they are caught strips the lore and the legend away, leaving just a person with depraved tastes and an impulse control problem. What interests you are not them but watching Sherlock best their efforts at remaining uncaught, listening to him strip through their rationalisations and deflections as he gets them to confess. ' _The clever ones want to get caught,_ ', he has told you, ' _they can't wait for the world to find out what they've done._ ' Sherlock is who many of them want to show off to most of all.

Sherlock, who's still not arrived. Lestrade glances at his clock, eager to process his detainee. "The fuck's taking him so long?" he asks you.

"He was just––" you start, just as a fourth car pulls up to the scene. You're just off the car park of the Princess Diana Memorial Fountain.

This is an unmarked vehicle driven by Donovan, and you're surprised to see Sherlock clambering out from the backseat. Donovan turns off the engine and climbs out herself, looking as put off as she always is when having to deal with Sherlock. You watch, that odd sense of concern you'd felt earlier upon seeing him returning full force as Sherlock is forced to lean his palms on his knees by the car, breathing hard still. There's a slight wobble when he tries to straighten his form and starts striding towards you, and it's Donovan of all people who has to grab hold of his arm, directing an angry glance at you as though you were neglecting your duties.

You left him behind because he told you to do that. He calls the shots, _always_. He was just a bit winded from all the running.

You're by his side, now, while he swats Donovan away and tries, to no avail, to catch his breath.

"Just dizzy. Stop fussing," he warns you both.

"He was sitting on the ground," Donovan says disapprovingly. "Didn't look like he was going to make it in time for the arrest." It sounds like she is trying to explain why she'd ever deign to offer Sherlock Holmes a ride.

You ignore her and direct your words at Sherlock. "When did you last eat something?" you demand.

This isn't the first time he's got dizzy on a crime scene. Any case stretching beyond three days, and you start seeing signs of fatigue and a lack of fluid and nutrition. He needs you, then, to keep him functional. Always needs you to remind him he's not just a brain, and that his mind needs fuel. You wonder how he managed before. Did Mycroft keep swooping in and taking him home for a stern talking-to and a plate of cold cuts? You suspect it might have been so, and Lestrade occasionally shows a tendency for nagging Sherlock about Transport maintenance, too. There's a friendship there which seems to span years before you met them. You haven't asked for details because a part of you senses it might not have been a very good time in Sherlock's life. He doesn't ask what yours was like before you got shot. There is only you and Sherlock now, united and both better for having met the other. No need to dwell on the past, is there?

You take his pulse from his radial artery, though you could have just counted the beats from his neck where distended veins over pale, slightly sweat-shiny skin are pulsating fast. He's very tachycardic, likely with some extrasystolic beats. Maybe this is the after-effect of nearly fainting from some vasovagal spell brought on by, well, not eating and drinking enough and then trying to break some sprinting record.

You berate yourself for not watching over him better. Then, you berate yourself for thinking you need to do that for a grown man.

He coughs. Maybe he's coming down with some virus. That seems the likeliest and would explain the sudden lack of exercise tolerance. As much as Sherlock likes to think he's above such pedestrian things, he does catch the odd gastroenteritis and respiratory bug and acts as though it's a reverse miracle that such a strange thing could happen to him. He studies his own mucus samples under the microscope until he falls asleep at the table. When that happens, you cover his shoulders with a blanket and deny — with absolute conviction — the intensity of the feelings you have for him when you get to see that vulnerable underbelly of his soul. You look after him and he lets you, a silent pact not meant for others to see.

Lestrade is watching you both, Marston firmly in his grasp. He's just about to shove the guy head-first into a marked police car. "Sherlock? Did you want to––" he starts asking.

Before, you could wave away the worst of your worries. Before, you just thought he was a bit dizzy. A bit winded. A bit this and that, maybe a head cold. Now, when you see Sherlock shake his head, witness him deny himself the chance to face the man who has run him ragged around London for weeks, you realise that he feels even more rotten than he looks. And he doesn't look too good at all.

"Could you give us a lift home?" you ask Donovan.

"Whatever," she says. She'll get to go home now, too, because the case is solved. She should be grateful to Sherlock for that, but she'd never admit to such a thing, so she's just going to drive you back to Baker Street.

In the car, Sherlock says nothing and simply continues breathing in a very conscientious manner, pulse still sky-high. You don't take his hand again; the gesture seems too intimate for Donovan's presence, but you can count the beats on his neck. You know you should be asking questions, making a cursory examination, but Sherlock always makes you second-guess yourself. Besides, he's walked away unscathed from such insane situations that a part of you is always sceptical that any of his symptoms are serious. It also doesn't help that a proper head cold will bring on such histrionics that you'd think he had the bubonic plague and not just a three-day snot virus.

Once parked in front of your home, you climb out of Donovan's car and thank her as joylessly as possible. Sherlock says nothing, but appears relieved at the sight of the front door. He manages to get out of the car and walk slowly the short distance to the entrance without visible difficulty. There, he waits for you to dig out your keys.

The stairs turn out to be a problem. He lags behind, breathing like a pair of bellows. Three times, you want to help him and three times you abort that mission, aware that he might snap at you. Your eyes go wide as he eventually calls out your name with pinched lips, hoarse and struggling to catch his breath. His colour is ashen, and you almost make him turn around so you could get back to the street and haul a cab to the nearest A&E. Almost. The safety of home beckons irrationally, and a part of you clings to the esoteric belief that if you get him up there, things will be better, and you can gather your wits about you together and solve this.

You know, of course, that this isn't his mystery to solve — it's yours, because this is your profession, but you still long for his genius to assist you. The pressure for answers grows immense as you descend three steps and wrap an arm around his waist, feel him sag against you.

"Together, yeah?" you ask, rhetorically, trying to reassure yourself as much as him.

Once in the flat, Sherlock collapses onto sitting on the sofa, sticks his head between his knees. He must be dizzy again. The muscles on his neck which connect to his clavicle are withdrawing with every breath, his chest expanding and deflating with the frequency of sea waves in a gale. He's not cyanotic, though, and you find that odd. There is no blue tinge on his lips, though he's in obvious respiratory distress. _He's not cyanotic yet, but might just be getting there_ , you tell yourself, and then want to make that thought evaporate just like he sometimes swishes away invisible things he digs out from his Mind Palace. You wish you had one right now — all your knowledge and experience arranged neatly, ready to be deployed. If your mind is anything, it's not a palace, but a closet stuffed too tight, and you don't want to open it in case things start falling out. Things you don't want to look at.

"Talk to me," you bark. Captain Watson has entered this space and taken over because John Watson is currently frightened and unfunctional. You were always shite at this when it was your family. Always got suspended in some gawking state of confoundment, even rather basic medical knowledge abandoning you. Thank fuck for mnemonics and protocols. They always saved you when there was someone you knew on the table — friends, fellow soldiers.

Sherlock kicks off his shoes — they seem oddly tight — and even peels off his socks. You can now see his ankles and shin and frown as you see thick trunks instead of the delicate bone structure you are used to after watching him promenade barefoot frequently in the flat. The elastics of his socks leave lace-like patterns in the doughy, puffy skin.

You kneel, sink your thumb above his medial malleolus. It leaves an indent which disappears very slowly. "When did this start?" When did it start, and why hasn't he told you? He always conceals these things, brushes them off. It's just the Transport. It's meaningless, unless it's betraying him to the extent that it can't be ignored as much as he tries.

This is one of those moments. Instead of imperious dismissal, there is an urgency in his gaze; he's pleading you wordlessly to fix this, because you're the doctor. You're _his_ doctor.

He doesn't seem to be recovering from ascending the stairs and now, he digs out one of his white-starched fabric hankies from his coat pocket, the dark wool sprawled around him like a cape on the sofa. "A week… maybe two," he tells you and coughs into the fabric.

Your breath hitches a bit, too: when he lowers his hand and you can see the scrunched-up white fabric, there are streaks of crimson there.

"What else?" you press, and when he doesn't immediately answer due to being mesmerised by the sight of the blood, you snap, "Sherlock! What _else_?"

"A bit… short of breath. Not much. Nothing… like… today," he gets out. Maybe he was a man of so few words in the car because even talking is a bit much.

"It got bad _when_?"

"Started running… after Marston. Got some… chest pain."

"Is that pain still going on? What's it like?"

"Don't… know," he answers and finally seems to be able to draw a calmer breath. He closes his eyes momentarily and leans against the backrest. "On the… stairs, yes. Haven't been… sleeping well."

"You never sleep well on cases," you point out, itching to go get your medical kit, but you want his story first. First week in medical college, they taught you that the legendary William Osler always told his students never to rush an anamnesis: ' _listen, and the patient tell you the diagnosis_ '. You're pretty sure Sir Osler never had to try to wrench the truth out of someone like Sherlock Holmes.

_Come on, Sherlock. Be as observant about yourself as you are about others._

"No, it was… a few weeks ago. Kept waking up sh… short of breath."

You can't delay getting your equipment any longer, and soon return to the sitting room with your bag. You don't keep the medication selection inside very well stocked because you rarely bring the kit on cases and most of it would expire. Lidocaine you always have, though, because you need it for suturing wound. Sherlock regularly gets himself cut and bruised on cases and prefers you to fix things. Always you. ' _It's always you, John Watson, you keep me right_.'

That's why you can't afford to be wrong now, can't allow false leads to lure you down roads leading to bogus diagnoses. Because he's relying on you.

He doesn't protest when you unbutton his jacket and shirt. Placing the stethoscope near the apex of his heart, you feel a flutter in your fingertips — like a bird trying to escape from inside cupped palms. You listen to one spot, two, three, and what you find is the same in all spots. It’s a long, intense murmur like an approaching wave. It's coarse, rumbling, systolic, and loudest near the apex. The trill you felt in your fingers could be blood flowing back turbulently. Lots of it. His pulse is strong on his neck, weaker in his fingers, which are now cold and sweaty but swollen — why hadn't you noticed that before? You always watch his hands because they're beautiful and graceful and watching them is less inconspicuous than fixating on his face.

"Has anyone ever said you've got a murmur?

"No."

"Have you even had echoc–– a heart ultrasound done?"

"Years ago. Normal."

"Well, you definitely need that exam redone now."

You put down the stethoscope, pull your phone out of your jeans pocket and dial the number for the emergency services. Sherlock hears it all and doesn't protest.

**Notes for the Chapter:**

> tachycardia = faster-than-normal heart rate  
> extrasystolic beat = a beat produced by some other area in the heart than the sinus node which is normally responsible for pacing. These can originate from nearly anywhere in the heart, and the general area of origin can be deduced from what they look like on an ECG.  
> heart rate vs pulse = the heart rate is the rate at which the conductive system fires triggering impulses to the cardiac muscle to contract. The pulse are the fluctuations in blood pressure produced by the heart muscle contracting. One can have a heart rate but no pulse if, for instance, a person in cardiac arrest has a pacemaker that is still functioning.  
> gastroenteritis = stomach flu  
> respiratory = having to with breathing. A upper respiratory infection essentially means a head cold. A lower respiratory infection would be a bronchitis or a pneumonia.  
> mucus = snot. See, John’s got some fancy vocabulary, too.  
> apex of the heart = the pointed bit at the bottom mostly formed by the bottom bit of the left ventricle  
> turbulent in terms of blood flow = as opposed to laminar, which means a flow without any maelstroms, turbulent flow is like that of a river with lots of rocks. To put it in more scientific terms, there are changes in pressure and flow velocity in a turbulent flow while in a laminar flow those things are more constant.  
> echocardiogram = a detailed ultrasound examination of the heart


	2. Flood

**Notes for the Chapter:**

> Kicking this chapter out took longer than expected — teaching work and two Halloween parties kept me hella busy this week!
> 
> You can find explanations for all the medical terms in the chapter's closing notes.

It's Hammersmith Hospital this time, a rarity in that you haven't been there before. Thanks to the risks of the Work, you are better acquainted with the various A&E departments of London's major hospitals than you ever were as a surgical trainee before joining the RAMC. Sherlock is taken to this unit of the Imperial College Healthcare NHS Trust because it is one of London's seven designated Heart Attack Centres, and the closest to Baker Street. You can't know that a coronary incident is what Sherlock is experiencing, but the chest pain, the dyspnoea and the swollen ankles and the tachycardia could well point to that, as well as the signs of left-side strain on the ECG the EMTs had done and sent ahead to the hospital. There's also the murmur which widens the range of potential diagnoses.

There are rules of thumb you have learned while living and working with Sherlock: first of all, he may fail to notice minor injuries. Secondly, he ignores ones slightly worse than minor. Thirdly, when he stops ignoring things, things are serious. Today, you create a fourth rule: when Sherlock _volunteers_ information about how he's feeling, things have to be beyond dire.

He keeps you updated in the ambulance. Wide-eyed at every attempt at making him more comfortable and visibly circling panic, he only calms down once the back of the trolley is raised up so he can be half-seated. You don't know what to do with your hands, since encroaching on the territory of the obviously very competent EMTs would likely just mess up their workflow and routines. You tell yourself you will intervene if they leave something undone — if there seems to be a stone turned in trying to make Sherlock more comfortable. He's having oxygen with a mask he keeps readjusting, a bit of morphine — too little, you suspect, considering his tolerance. A sublingual nitro-glycerine spray was discussed while still in the flat, but the idea withdrawn because of low blood pressure. That's why raising the head of the trolley had not been a welcome idea at first. Fluids are running — standard solution to most acute problems involving low BP, but the sign of the Hartmann's makes you uneasy because you keep thinking of his swollen ankles. Where will the fluid go once it seeps out of his blood vessels?

The list of symptoms is a constant mantra in your head: haemoptysis, dyspnoea, peripheral oedema, chest pain, tachycardia, hypotension.

He coughs weakly, his lungs then heaving.

"Any more blood coming up?" you ask.

Sherlock shakes his head, which makes a curl tangle with the elastic of the oxygen mask.

"Good, good," you tell him. Not that it means much beyond him not bleeding profusely into his trachea. It doesn't mean this isn't dead serious.

You know he still smokes. You push away worst-case scenarios involving tumours squeezing shut major blood vessels. You tell yourself you would have noticed symptoms before this. There would have been a cough. There would have been… something. This is too much, too fast for a tumour, isn't it? Isn't it?

Your ears pick up something that sounds like your name.

"How long?" are the next muted words you hear over the hiss of the oxygen.

Normally, Sherlock would never look forward to an A&E visit, wouldn't be eager to get there. Nothing about today is normal.

"Just a few minutes," you promise, seeking confirmation from the EMT who's in the back with the two of you. You get a nod. "Any better?" you then ask Sherlock with the smile of a shark. Though there have been no complaints, you're always felt as though you never quite developed the reassuring, calm crisis demeanour of the colleagues you admired for their bedside manner. You're one of those people who can't force a smile to reach their eyes; the anger and the worry always pinch your features tight, and you imagine you look like a wax mask.

Sherlock shrugs, a jerky little thing because his posture is very tight, shoulders drawn towards his sternum. "It's all… relative," he manages.

This morning, you thought he was healthy. Yes, it's all very bloody relative right now. Speaking of: "Should I call Mycroft?"

"He'll probably… arrive before us."

This turns out not to be true. Maybe he's out of the country or maybe he's attended to Sherlock's A&E visits enough times to have developed some kind of sixth sense about when things are serious and when there's but a scratch. Then again, if this isn't serious, then you will have to reconsider seriously your belief in your professional skills.

 _Hammersmith, Hammersmith, why does it feel so familiar…?_ Not the building itself but the name?

You're still trying to work that one out as you jog after the trolley into the acute bay. Nobody tries to prevent you from entering, and they all treat you as though you work there. Perhaps Mycroft does already know you are here and has made some calls.

In the acute bay, you try to keep out of the way but within sight of Sherlock, upon whom a swarm of staff descends. Bloods are drawn, a thoracic x-ray taken with a film placed under his back. He gets morphine, a diuretic. You half-expect him to be given aspirin for chewing or the nitro-glycerine spray that was aborted earlier under the tongue, but those don't materialise. You tell the emergency physician and the consultant internist about the murmur and the chest pain, and on the ECG taken by the ambulance and now taken again, there are signs of severe strain on the left side of Sherlock's heart. Is it a coronary infarction; is that what they're treating? Perhaps not, since typical signs of it are not visible in the film. Then again, when has Sherlock done anything the usual way? You feel the need, the push for a diagnosis in the conversations and actions of those around you because there can be no treatment without a cause. That's how they taught you in med school: here is the name of the illness, and this is how you treat it. They rarely approached things symptoms first. You often felt, as a trainee, that the approach had been all wrong and did little to prepare you for moments like this.

"He smokes," you tell anyone who listens.

"You don't know your cholesterol levels, do you?" you ask Sherlock, who shakes his head. You realise the internist had already asked this. You're useless. You can't order exams, can't make decisions.

"My father… and Mycroft… both on statins."

"Could run in the family, then," you tell him. Risk factors, prognoses, procedures. You long for a wound to suture, a fracture to reposition. Not this, not something where you can't just reach in and fix it.

The emergency physician is fast but thorough, and he's working together with the internist, perhaps because of the urgency of the situation. They confirm your findings, then say that a cardiology consult is needed. "We're getting a CT done first, though, to rule out ascending aortic dissection."

That hadn't even occurred to you, and you want to kick yourself. Nitro-glycerine and aspirin would truly be a terrible idea in that scenario. There's noradrenalin infusing now and the diuretics, and another shot of morphine has made Sherlock stop clawing off his oxygen mask. His blood pressure is still low and his heart rate high, which you suspect will be difficult to remedy without addressing the cause.

The CT room is right next to acute bay, which means you're not separated from him for long. You don't try to finagle your way into the radiologist's room next to it — by now, you have grown to trust the staff to tell you and Sherlock what's going on, to do the right things to get forward. Once he's back in the acute bay, you stand by his bed like a sentry. You long for more medications, more infuser pump, more exams, _anything_ to fix the fact that Sherlock doesn't look any better than he did when he was wheeled in, and it's been an hour. You nearly decide to commandeer the portable ultrasound used for cannulation and nerve blocks that just sits in the bay's corner, mocking you with the answers it could provide. As much as you itch to take things into your own hands, you can't risk getting thrown out for bypassing standard operating procedure by taking liberties. You're not a cardiologist. You're not anything that could fix this. You're Sherlock's friend and partner and companion and flatmate and his… his… but that's been side-swiped by the need to be his doctor.

"No dissection. It's got to be a valve issue," the internal medicine consultant tells you when she returns, crumbs on her sleeve. "I've called cardiology; we've got an ultrasound room in the next corridor they use for acute cases. Dr Stamford promised to be here shortly."

Dr Stam–– _that's_ why the name of the hospital has rung a bell! Longing for a career change with more clinical work after teaching medical students for years on end at Barts, Hammersmith is where Mike had been hired as a consultant cardiologist. It's the best news you've heard all day — not just because you think he'll be liable to being quick and making concessions, but because you know he is really, really good at what he does.

"Did you hear that?" you ask Sherlock. "It'll be Mike."

Sherlock ignores you. His phone has just chimed with a text which he glances before tossing the phone to you, coughing. It sounds a bit wet, and when he removes a tissue from in front of his mouth, there are streaks of crimson on it.

God, you wish you'd paid more attention during the pulmonology course. And paid even more attention during the cardiology course. What could cause haemoptysis while still looking like primarily a cardiac issue?

"You haven't––" Sherlock gasps, "worked it… out yet, then." It sounds rhetorical. He's read it on your face that you're as uncertain as the rest of the staff at this point. "Lestrade," he adds, nodding towards the phone in your hand.

After a case which involved the both of you tied up in a cellar and your old phone having been flung into a river you had agreed to share the key codes to each other's phones. His is his birth year reversed. You unlock it and read the text from the DI; Donovan had mentioned something to him about Sherlock looking worse for wear, so he's inquiring whether everything is alright.

You respond from your own phone: ' _At A &E. Will keep you updated._'

The reply comes instantaneously. You can't say much more, not without Sherlock's permission, and keeping Lestrade updated isn't a very high priority now.

 _'How bad is it?_ ' he asks.

You don't respond, because it occurs to you that there are other people who should be kept in the loop more urgently. "I assume Mycroft––"

"––will land–– his broomstick… any minute," Sherlock manages.

"What about your parents?"

Sherlock flaps a dismissive, shaky hand in your direction. "Mycroft will… sort them."

"You don't need to be worried," you promise, then want to bite your tongue when you see his sceptical expression. His gaze isn't as sharp as usual — he looks distant, distracted, alarmed.

"I don't?" he asks sarcastically. "I can–– see–– you are," he breathes out.

____________

"You see that?" Mike asks, pointing at the jet of turbulent blood flowing from the left ventricle into the atrium. It's supposed to be going in the opposite direction so that it could then be pumped into the aorta. "That's a regurgitation fraction of over seventy percent. And that part of the valve that looks like it's flapping in the wind — that's the cause," he tells Sherlock with courteous enthusiasm. "The chordae must have snapped suddenly. John said that you were chasing someone? Not the first time it's happened during sports if there is a weak spot."

Sherlock is lying on his left side on the trolley, facing the large ultrasound machine. He is watching wordlessly what Mike is pointing at on the screen while tilting and twisting the probe as he locates and records different projections of the mitral valve.

You're behind the trolley, seeing what they are seeing. Sherlock looks enraptured by the moving black-and-white images with occasional puffs of colour. Mike turns off the Doppler function again before inspecting the left ventricle muscle as it contracts. You can see it's working hard, barely pausing between contractions as it attempts to pump as much as it can of the blood arriving in its chamber into the aorta before is starts receding back into the atrium.

You wonder how much Sherlock understands of what he's seeing; he is probably well-versed in the anatomy of all major organs, but only a physician could glean from Mike's explanation the severity of the situation. You feel an urgency to make sure it hits home. You don't do it to be cruel — you do it to be kind to a man for whom information is always the lifeline that keeps his world organised and preserves his sense of control over his life.

"Your mitral valve isn't holding at all. Because the blood keeps going back to the atrium, there's not enough blood circulating in your––" you start to explain.

"I've _got it, thank you_ ," Sherlock says pointedly. "Does the backflow... cause... the pulmonary congestion?" This question is directed at Mike.

You want to kick yourself for underestimating Sherlock. When you're ill, you want to lose a bit of the burden of being a doctor, want things explained to you in a way that you are certain to understand. You're a surgeon, not a jack of all medical trades; you don't understand more about ophthalmology or nephrology than a recent medical graduate. Sometimes you feel like Sherlock just might have you beat when it comes to knowledge about the human body, especially when it comes to ways in which it can be harmed, its life snuffed out. You suspect that he's doesn't often consider a heart problem as a potential cause of death — a valve just giving away. Natural causes, disease and old age don't interest him. Violent, unnatural things do, things that shock and leave a mark in the fabric of society. Not quiet, private tragedies such as natural illness.

"It does, yeah," Mike replies enthusiastically. He has a good bedside manner and you hope that his keen interest in what he's just diagnosed is contagious enough to help Sherlock digest the news.

If Sherlock could cling to a morbid fascination of the pathology, perhaps it wouldn't rattle him to the core. That's what you hope, because you don't want him to be frightened. He rarely is, and his bravery gives you courage. You have the upper hand right now because of your profession, and you don't like it. You prefer it when Sherlock takes the lead.

You're startled when Sherlock sticks out a hand, and your brain scrambles to interpret the gesture. Finally, it dawns that he needs a tissue. He coughs into it, then quickly and covertly folds it up so you don't see what. Aren't you a bit past the point of trying to hide things? _Blood_ , you remind yourself. His lungs are so congested with the backflowing blood that small vessels in them are bursting.

The infuser pump screwed into the IV pole gives a warning of running out of its frusemide infusion.

"I assume a... valve issue such as this... can be repaired?" Sherlock asks. His strained baritone barely wavers. Barely.

Mike is looking at you now, as though seeking backup. "Holosystolic jet, vena contracta over oh point nine centimetres. The opening is more than oh point eight square centimetres from this projection. E-wave dominant," he muses.

You glare at him though you like him. You're not a cardiologist. You want it spelled out, too. "It's been a while since my A&E days. What's the verdict?"

You lean slightly forward, your chest now almost touching Sherlock's arm, which is resting on his hip. It's the only source of warmth in the room. The veins on the backs of his hands are distended and you think: _that's good, because they'll need large cannulas for the––_

"Surgery," Mike concludes your though with a grimace. "Wouldn't be surprised if they took you into theatre tonight. I'm going to have a word with Mr Cowie — he's our head of cardiothoracic surgery and happens to be on call tonight. I promised to rush him an oesophageal echo later so he owes me one," Mike says sunnily.

Sherlock swallows. "Surgery? Not... angiography or…"

"Angiography is what it says on the tin — happens inside blood vessels. There is a procedure which interventional radiologists can perform on mitral valves, but that's just for patients who can't tolerate a surgical repair. You're young, fit, you can have a proper repair. I can't say what they'll do to the valve — ninety percent of the time these days they can do a plasty, which means sewing up the broken bits so you get to keep your own. It's just that… with damage this big, I'd say you're potentially looking at a valve replacement. We'll see if Alex — that's Dr Cowie — wants a cardiac CT to get a closer look at the parts surrounding the snapped chordae. That can determine whether there's enough healthy tissue to re-anchor the broken parts."

"I already had a CT," Sherlock says indignantly.

"Different slices, different projections. Not enough for this."

Sherlock's chin juts up stubbornly, and his lips part as though he's about to say something. _Please don't ask it, please just don't––_ you scramble to think as though you could telepathically shut him up. You can't because he's Sherlock, so of course he will ask the question you don't want to hear. Stubborn, fiercely independent Sherlock.

"And if I decide.... to not have—- the surgery?"

There it is. You are almost entirely fully certain he's asking this just out of academic interest. You desperately hope so. You bite your lip to give Mike a chance to answer first, but you're so tempted to shake Sherlock until he sees sense.

Mike removes his gloves, drops them into a bin and rises to his feet. He's a burly and not very tall man, but right now he towers over his hesitant patient. "You're already in full cardiac dysfunction. Your left ventricle will desperately try to keep you alive until it can't, and that moment is not far, so I'm going to go find you a surgeon," he says and gives Sherlock's arm a haphazard pat. "We'll get you sorted."

After the door closes behind Mike, leaving the two of you alone in the dimly lit room, Sherlock is breathing hard again and trying, in vain, to conceal it. The oxygen prongs won't soon be enough, nor will just an oxygen mask. As his lungs continue to fill with fluid, he'll need counterpressure from a CPAP mask or a respirator to get enough oxygen and to remove carbon dioxide. He has to know how serious this is. He has to, but you wouldn't put it past him to select his go-to defence mechanism — denial.

The moment feels opportune — it's been a whiplash of a day and you want to gauge his mood without others fussing around. In the dim light, he looks young. Pale. His breathing has become even worse after the exam ended, and for a moment you worry that he'll up on a vent even before the surgery. Once you manage to calm your own pounding heart morse-coding the words _don't want to lose you today_ , you read the anxiety twisting his features and accept it for what it is.

An involuntary shudder passes through him, and then he tells you, offers you freely the truth of at least one thing that bothers him. It's so uncharacteristic of him it leaves you reeling to admit to something bothering him.

"Get. this. _off me_ ," are the words he pushes out from behind clenched teeth. He then swipes off a bit of the ultrasound gel left on his bare chest with his finger, then wipes it off on his peach-coloured hospital pyjama bottoms. He cleans the finger so meticulously it borders on neurotic, and you realise that this has got to be about sensory issues you know about but never try to discuss. They have turned the innocuous, now body-temperature ultrasound gel into a method of torture.

You do your best with tissues hastily pulled out of a receptacle. The flutter you feel as you pass the tissues across his heart is different now — sharper, more frantic. You glance at the ultrasound machine that's still on, still recording his rhythm through three ECG electrodes dotting his chest. It gives you the answer: he's gone into atrial fibrillation, the function of his left ventricle so erratic that his left atrium cannot keep up so has dissolved into tachycardic chaos. He needs this surgery as soon as possible, so he needs to accept the idea of it right now.

"It's a lot," you offer, wondering if he's cold. He could put the pyjama top back on if he wanted, but he remains lying on his side, hands lax beside. "It's a lot to take in," you continue, hoping that he'll take the bait, that he'll talk to you. You're hoping that you won't have to navigate the usual maze of his non-communication, wouldn't have to hope to find treasure at the centre instead of some monstrous trauma you don't want to awaken inadvertently. There's no time. You have to deal with this now.

Finally, he nods.

"At least you won't have to spend months worrying about a potential operation," you say, disgusted with the forced cheeriness of your tone. "It'll be over and done with quickly. Easy decision. A no-brainer, really."

"Is it?" Sherlock asks, and his tone is odd. Detached. Angry, and it seems to be directed at no one in particular. "Mycroft must have forged my signature by now."

You realise, once again, how desperately he must need to hold on to the marginal sense of control he still retains over his body. He needs it to be his decision. "The surgeon will come see you once he's seen the scans and explain everything."

"No," Sherlock corrects, and coughs into a crumpled-up tissue. You deliberately avoid looking at it, not wanting to see whether there's more blood.

"He'll spout… a–– bunch of jargon… which you will then explain," Sherlock corrects tiredly. The sudden defeat in his tone is frighteningly far from how he usually behaves in hospitals. It has sunk in how serious this is, and he's losing control over his moods, which are a weathervane with a screw loose on the best of days.

You think of his brother whose only way of expressing love and concern is to snark, nag, berate and bully. Somehow, you just know there will be no Holmes parents appearing before the operation is over and done with. You're all Sherlock has got right now, and anyone in his situation would be overwhelmed and scared.

"It's not your fault," you say weakly. "You were probably just born with a weak spot in the valve structure."

Incidentally, he's now also thinking of his brother. "Mycroft would disagree with you. I'm sure he'll inform you I did this to myself."

"You don't take very good care of yourself, no, but you didn't do this."

He averts his gaze. It's odd, seeing him this defeated. This empty of arguments. Problems and challenges and tragedies send him into high alert usually, into battle mode. Now, the bowels of this hospital have swallowed him up and he's probably wondering in what sort of shape he'll be spat out.

"Do you want me to keep Mycroft out of this?" you ask. "I will," you declare and mean it.

"It's no use. Besides, he'll… get you access to… wherever I am."

He's right, of course. A snap of Holmesian fingers and laws of confidentiality and hospital policy sweeps aside like the Red Sea.

"I won't be in the OR," you reply. "I'll follow you anywhere, but not there."

"Why?"

There's a concerned innocence in his tone, as though he expects you to stand guard as he's being operated on.

"I can't–– won't watch them––" you trail out, quickly aborting the words you'd almost said. They would upset him. Frailty, weakness and infirmity upset him. _I'm not watching them saw your sternum open_ , you conclude in your head. You don't want to see that his heart is like everyone else's, how it's giving up. You shouldn't need him to be larger than life in that way, but he _is_ your life. You held a heart once as a medical student, held it steady as instructed during an off-pump coronary bypass as the surgeon attached transplanted vessels into their destination.

You can't watch someone else holding Sherlock's.

There's an image frozen on the ultrasound machine screen of the colourful jet of blood flowing back and filling Sherlock's entire left atrium. He's looking at it, lips parted as he tries to breathe deeply enough, but his lungs can't take over from other organs, just struggle to compensate for what's wrong.

You place a hand on his shoulder. He doesn't look at it, doesn't shrug it away. His skin is clammy, warm, his neck veins thick and soft. The pulse pounding where your thumb lands next to his clavicle is frantic and irregular.

His heart is breaking apart, and all you want in the world is to give him yours.

**Notes for the Chapter:**

> ECG = electrocardiogram. It registers the electric activity of the heart’s conducting system, and various problems putting the heart muscle under strain can affect that conductivity. A coronary infarction, for instance, can cause changes in the ST-interval reflecting how impulses travel back and forth in the ventricles.
> 
> Heart murmur = the heart sounds and murmurs associated with them are caused by the heart valves opening and closing. A murmur can be caused by narrowing, aka stenosis, of the opening of a valve, or backflow through a leaky valve. It helps to think about a river: when there are rocks and narrow bits the flow becomes more turbulent and whirly, causing a louder sound.
> 
> nitro-glycerine as a drug = expands coronary vessels, providing them with more blood flow and oxygen. Helps with symptoms when there is coronary ischaemia, ie the heart muscle looked after by the coronary arteries is not getting enough oxygenated blood.
> 
> haemoptysis = coughing up blood
> 
> dyspnoea = difficulty breathing, feeling short of breath
> 
> peripheral oedema = swollen extremities (fingers, ankles…)
> 
> hypotension = low BP
> 
> trachea = windpipe
> 
> Heart ultrasound aka echocardiography = while the ECG gives you information on the electric conduction in the heart, an ultrasound can show you the structures directly, allowing you to estimate the efficacy of the different bits in contracting and to see how the blood moves within those spaces. Complicated measurements can be made based on the findings, which is what Mike is doing to grade the severity of the mitral leak.
> 
> Mitral valve = the valve between the left ventricle and the left atrium. It’s attached to the ventricle via tendons called chordae tendinae, and if those snap, the valve begins to leak a lot. This is where the story gets its name! If the blood flows back into the atrium, the ventricle where it was supposed to go can’t pump enough of it into the aorta and consequently to the rest of the body. Hence the low BP. The blood ends up congesting the lungs because that’s where it arrived in the atrium from.


	3. Witness

**Notes for the Chapter:**

> Glossary of medical terms at the end of the chapter as usual. I thought it might be a nice Sunday surprise to kick out another chapter since we've only had one this week.

As a trauma surgical trainee, you were taught that nothing should delay fixing a life-threatening bleed, that nothing done to stabilise a patient should obfuscate the most important goal: to get them into an operating room the minute it is ready to receive them.

Sherlock is deteriorating by the hour. What’s taking them so long in organising theatre time? Surely, some geriatric with a less urgent issue could wait? You feel guilty for such reasoning, but only for a moment. This is Sherlock — _fuck_ everyone else. You shot a man for him. You're not far from threatening another to ensure life-saving treatment.

You've always had a temper. It has got you into trouble: bar brawls, warnings from bosses when you're spoken your mind to some drunken idiot instead of just plastering on a fake smile and stretching the limits of the empathy you've always suspected you were given less of than many other doctors. You didn't need it that much in Kandahar — what was needed there was a take-charge-attitude and skilled hands. And somehow, in losing the latter, you lost the former.

Until you met Sherlock. Until you learned that there is safety in numbers, and that you like having someone to rely on as well as he does. That a surgeon isn't all you are. That there are many kinds of strength, and you still see his underneath the fear and the malaise which shroud his personality right now. He's the bravest man you've met — and the most brittle.

A CCU nurse appears to give him morphine — it's less for pain, more for limiting the sensation of not getting enough oxygen, which is stressing him and stretching his physical reserves even more. If he’s on his back, the shortness of breath becomes intolerable. If he sits up, his blood pressure tanks despite the vasoactive infusions. Every time you return after being asked to step out, there are new wires or cannulas. Arterial line, urine catheter, a central line as thick as a drinking straw. New drugs are introduced: milrinone, levosimendan… anything and everything to make him more comfortable and to squeeze out every last ounce of strength from a heart that’s been thrown into the deep end with cement boots on. Had this developed slower, it would have thickened its muscle layers like the deltoids of a heavyweight champion. You tell yourself it’s a good thing it hasn’t — no permanent damage. Sherlock wouldn’t settle for less, you remind yourself. But the lack of such adaptive changes means that since this came on very suddenly, his heart is struggling terribly.

By sunset, his rhythm is a mixture of rapid atrial fibrillation and frequent ventricular extrasystoles. Mike tells you that they won’t go for a cardioversion — using electricity to revert back to sinus rhythm — because the short anaesthesia needed is risky right now. Even if it would just mean a relatively small dose of propofol, it might kill him. They also don't want to lower the heart rate because that is currently what his heart depends on in getting at least some blood pushed into the aorta before it all flows back.

There are few words exchanged between you and Sherlock. You talk in glances, touches, presence. His is that of a restless wight hoping to escape out the window like a bird frightened to flight. Yours, you hope, is steady; a rock to lean on. You don't feel such an equilibrium but summon whatever skills you hope you've amassed in your years as a doctor to project it. A false calm, a cheap balm, the effects of which are little more than placebo, but it's something. You hold his hand, and it astonishes you how natural it feels. It also makes you feel guilty, because you wish you could do it outside of these circumstances. Such a quaint, chaste gesture — you never long for such things with women. With them, you like to sidestep such things as kissing as much as you can, because they feel like those gestures belong to someone else. Why does it feel that way? Why can you fuck them, but fear anything that might spark an emotional connection?

Why do you want the touch of this clammy, shaky hand enclosed in yours tonight more than their bodies and their attention?

Why does Sherlock always flay bare your priorities?

You only break your physical connection with him for the short nap he manages to take. You sit in an uncomfortable chair by his bed, listening to his raspy breaths, fearing they'll suddenly cease. They don't. He's strong. He's strong enough. He has to be.

When the carbon dioxide levels in his arterial blood gas samples begin rising as a sign that he's approaching complete respiratory exhaustion, initiation of BiPAP is discussed. It is discussed, but in the end not executed because, in the middle of that conversation with the cardiac care unit intensivist, Mike and an unfamiliar face in scrubs enter, soon to be followed by several more. There is an urgency in the air which initially raises your heckles — more bad news?

When you spot the relieved smile on Mike’s face, your nerves settle a bit. He’s a shite liar who’s never been able to conceal worry or his seemingly endless reserves of interest and empathy for people from patients and their families. People like that, you are aware; they seem to think it’s empathetic and honest. The doctorly demeanour you developed — one you'd excused as being more business-like — produced occasional complaints that you seemed cold and uncaring.

When the cardiothoracic anaesthetist introduces himself and says it’s time, Sherlock’s hand finds yours on the bed rail and clasps it tightly. You slip your fingers between his. After waking up, he’s been withdrawn, so focused on breathing that it had made him hypersensitive to touch to the point of flinching. Now, he’s looking for a lifeline in the face of the unknown.

This morning, you watched him spout his deductions, all sharp angles and detached nobility, a hawk among the pigeons of the Met team. How could you get from that point to this in less than a day? To this half-existence of Sherlock's being distilled down to its bare essentials, clawing to climb onto the lowest rungs of Maslow's hierarchy: breath, blood, survival?

They give Sherlock a tablet of something with water — the explanation was brief, and you weren't paying attention. You hope it'll give Sherlock a respite from the stress.

It takes a while to reorganise the tangle of wires and tubing attached to him for transport and to shift the oxygen supply from the wall to a portable tank. Infusers need to be safely fastened for the trip down to the OR floor, reports given to the anaesthesia team on how he's doing. Sherlock’s eyes are closed, but he’s not asleep; his hand hasn’t gone lax in yours, and you can feel the nervous tension tightening his arm muscles. You wish desperately that you could do more, that you knew what to do, that the room wasn’t full of people and that you had the right words to give him confidence.

Your words cannot affect the outcome. The knowledge and skills of others will be the factor determining survival. That, and whether Sherlock’s heart hasn’t been too exhausted by having to push a tide back.

Still, you make a promise you cannot guarantee. You still do it, because even a lie is warranted if it helps him. "It's going to be okay," you tell Sherlock.

He nods, accepting if not your false promise then at least your motive for the transgression.

You don’t really listen to Mike’s report to the OR team. The surgeon had been by earlier to have what Sherlock had declared a pointless discussion of risks and benefits. If you consent, you might die. If you don’t consent, you will die. It was still a relief to see Sherlock sign the paper. He can be so bloody stubborn.

The bed brakes are disengaged. It’s happening, they're taking him, and a panic rises. Is this the last time you see him, speak to him?

“Let’s give that pumper a bit of a rest, eh?” The cardiac anaesthetist says jovially. ”By the time it needs to take over from the bypass system again, there will be a valve that holds,” he promises Sherlock.

You want to punch him, shove everyone out of the room so that you can be the one to make the such promises, because it’s unbearable that you can’t be the one to fix this. You’re a surgeon of the wrong kind, invalided home, and you hate the universe right now with the determination of a small child, even if by robbing you of your career it also gave you Sherlock Holmes.

You don't want him to be alone with these people. You slot yourself between the bed and a theatre nurse, perch your hands on Sherlock’s shoulders, fingers curling into his thin frame. You lean close, so close your foreheads nearly touch.

"We'll take good care of your partner, Doctor Watson," the anaesthetist promises.

”I’ll be waiting,” you promise. ”I’ll be at the ITU when you wake up. You won’t be alone. I promise.”

Sherlock doesn’t deal well with medical attention, hates strangers touching him. He can be confused and restless emerging from anaesthesia. You know this from experience. He’s prone to agitation and nausea even after smaller operations, let alone waking up at the ITU with his sternum sawed open and wired shut, drains coming out of his chest.

You will be there, so help you God, to remind him who he is and who you are. That's all that matters, not this place.

You tuck away a dark curl snagged on the elastic of the eight percent venturi oxygen mask and finally, he looks into your eyes. The apprehension and bare fear you see are to be expected, but still jarring.

”See you soon,” you say as you retreat, because this cannot be goodbye.

  
______________

There is no respite, no refuge from the crushing worry and anxiety. You wander the corridors of the hospital, confounded by how you can possibly feel so like a fish out of water though you have whittled away endless hours in places like this, spent days and nights attending to patients and making exactly the sorts of decisions which had led to Sherlock being taken away from you, off somewhere into a cardiothoracic operating theatre. Why hadn't you demanded to accompany him until the general anaesthesia was administered? Would Sherlock have wanted you there, or wasted his weak breaths to chastise you for fussing? Where is Mycroft Holmes when you need him to remove some more rules and obstacles?

As a doctor, you've always hated people who demand special treatment, unless it is for legitimate medical reasons. Sherlock's lack of cooperation with medical staff has always been tinged with trauma and panic, perhaps coloured by past bad experiences. You know he used to do intravenous drugs, and such patients don't often get the best treatment at A&Es. There are also his sensory issues, his fierce independence, his… _sherlockness_. He is bad at expressing his fears and worries; lying on a table at the mercy of a large OR team, staring at the machines and surgical equipment being prepared would frighten _anyone_. You pray for a swift, uneventful anaesthesia induction by a skilled team capable of ensuring that every patient gets administered enough of hypnotics. You hope for the best surgeon who does these operations every week. You try not to think of a chest being cut open, of blood being drained into the roller pumps of a cardiac bypass. You try not to think, period, but that just makes things worse. How can you forget any of it, when the very place you wander the halls of like some vengeful wight offers no respite from the sense of illness?

You can't lose him. Sherlock bloody Holmes cannot go down like this — not because of a dodgy heart valve. No, it's got to be deep in the Game, in the heat of the chase. Or, perhaps as a ninety-something with a violin in hand, at dusk in a garden somewhere with bees buzzing about. That's what Sherlock had told you once — that he wanted to retire to Sussex with _someone_.

' _Sounds so lovely_ ,' you had said, ' _I wouldn't mind a retirement like that_ '. And he looked at you as though a pact had been made.

______________

  
There's no official waiting area for the surgical unit, and you can't really wait at the East intensive care unit, either, since Sherlock won't officially have a bed there until the surgery ends. The surgeon had explained that Sherlock would be moved there directly from the operating room, intubated and sedated. His heart would need some time to stabilise before he could be allowed to wake up. This seemed to unsettle Sherlock more than the surgeon's brief descriptions of the phases of the operation.

Your phone bursts to life on your second circuit of the cafeteria atrium.

"Where are you, precisely?" Mycroft Holmes asks without so much as a _hello_. "The GPS here leaves a lot to be desired."

"Café, second floor."

"I was on a military flight back from South Korea," the older Holmes explains, "I came here directly from Brize Norton. There was a strict no-communication-order during the flight, so I couldn't…" he trails out, swallows. "Fill me in, please."

Such politeness is unusual, and indicative of distress in such a reserved, stern man.

"He's in the OR," you start.

"I'm aware of that," Mycroft says brusquely. "What is the precise nature of the problem?"

"Some tendons connecting his mitral valve to his left ventricle have ruptured, and there's a severe valve dysfunction which needs urgent surgery."

"Replacement or repair?"

"They couldn't say for sure before getting to the playing field. I think." You can't recall all the details of today's conversations; you'd been too focused on observing Sherlock reacting to them.

"You _think_?" Mycroft's disappointment is visible.

 _What does it matter?_ You want to ask. Mycroft's opinion or how informed he is wouldn't affect the plan here; it's the surgeon's job to decide what the best course of action is. Sherlock had not many asked questions, had not challenged the plan. He'd signed the papers without even waiting to hear the rest of the explanation, and that had spoken volumes to you about how worried he was about deteriorating further.

You now notice Mycroft carrying a laptop and no other bags. He notices your eyes roving his form and lifts the computer. "The rest of my things have been delivered home. This is for you and, by extension, me."

He opens the lid, and you're astounded to see what looks like the user interface of intensive care patient records. He places it on the cafeteria table in front of you. Next to it, your tea's gone cold.

Mycroft takes a seat opposite. "Thankfully, Hammersmith has joined the twenty-first century and their operating rooms employ a centralised, completely computerised system which collects data from patient monitors and infuser pumps, plus the team can input data by hand on the progress of surgery and anaesthesia."

"I'm not sure…" you hesitate, staring at the screen. Your table is in a secluded corner, but you still glance around, worried someone will think you've stolen a hospital laptop. "Not sure I should be looking at this."

"I refuse to rely on waiting for someone to come give us a watered-down summary. You know how to interpret all this." He nods towards the screen.

"Not all of it, at least not very well." The readings from the pulmonary arterial catheter offer you little insight since you don't even know what the reference values are.

Mycroft is right, though: you can't _not_ look. Oxygen saturation ninety-eight percent — entirely normal. Ventilation values: peak driving pressures are a bit high due to the pulmonary congestion, which is to be expected. Blood pressure: low-ish but not catastrophic, fluctuating.

Suddenly, the rhythm in the ECG graph changes. There are clusters of ventricular extra beats, then pauses of increasing length. Then, it degenerates into just a straight line which, at first, wavers a bit, then becomes the unmistakeable horizon of asystole. You knew to expect it, but Mycroft, craning his neck so that he can see the screen as well, does not.

"What just happened?" he demands.

"The surgery is well underway," you reply. "They've put him on cardiopulmonary bypass. Stopped his heart so that it's easier to fix the valve."

"Is that… safe?" Mycroft is frowning.

"Safe is a bit relative right now. They do this all the time," you reassure him, "and I think that graph there, marked INVOS, monitors his brain perfusion." You recall the surgeon mentioning it, and Sherlock looking more interested than he'd been in any of the details before that. The role of that monitoring device is to protect his brain. It's hardly surprising he'd find reassurance in its existence.

As much as you try to push away reality right now, Mycroft's reaction has hammered it home what has happened. Sherlock's life is now very concretely in the hands of OR staff, his life hanging on by a blood pressure produced by machines. His blood has been made so runny that it won't coagulate in the perfusion machinery which heavily activates clotting cascades. Just a nick on his finger, and he could bleed dry right now.

"Mortality rate?" Mycroft asks, having regained his composure. He sounds like he's haggling a prize at a bazaar.

"Normally 2–8 percent, but in the shape he's in, the surgeon estimated it to be about 30%."

"I knew it. I _knew_ he would neglect the follow-ups. He always ignores his health, mostly just to spite those who care about him," Mycroft curses.

"What follow-ups?"

"He had endocarditis in 2008. No significant valve defect developed then, and we were told that the antibiotics cleared it all up, but there was something they wanted to monitor via echocardiography once a year. I'm sure he never attended any of those appointments. His self-care and life management in those days was… non-existent."

You're not sure it's very great even now that Sherlock is sober, working, and seems even happy. Mycroft's story makes you wonder how bleak the reality had been which had created the dark shadows passing through the older Holmes' expression as he speaks of those days. There is a grey, pervasive heaviness you still sense sometimes in Sherlock; not quite a darkness but something old lingering behind, dragging at his heels. It feels like inklings of things buried, contained but not entirely controlled. Sherlock clings to his intellect like a lifeline on the roiling seas of emotions he doesn't seem to understand very well. He feels one thing and, in his frustration, might end up expressing the opposite. He's an open book and a shuttered dungeon at the same time.

Mycroft stands up, adjusts his vest and buttons up his jacket again. "Forgive me; there are things which I must attend to, and I would rather make myself useful to my employer instead of waiting and fretting."

He's leaving that part to you.

"It would be much appreciated if you could keep me updated," he says, nodding towards the laptop. The ECG is still blinking red as a warning, but the pulse oximeter is showing a flat-ish but existent curve and there _is_ a blood pressure — low, but it's there. It needs to be high enough to preserve his brain; Sherlock wouldn't forgive you if there was damage. He'd hold you accountable for not telling him about such a risk because he trusts you to tell him the truth. He wouldn't settle for anything less than perfection, not for anything less than his old self.

"I'll go see him once they take him to the cardiac intensive care unit," you say.

Mycroft consults the notebook he always keeps in a pocket. "The East Intensive Care Ward."

"Yeah, that's what they told me. They won't wean him off and extubate for at least a few hours, possibly not today if he's not stable enough."

"Could you…" Mycroft seems to be deciding how to phrase his request, "…if you might tell me when he's being awakened? There is little point in my presence until then. There are… memories I'd rather not revisit more than I must."

You're sure that these long hours away from Sherlock are memories you won't want to revisit, either.

"I'll text you," you promise, and he leaves with a nod.

You don't really enjoy the company of Mycroft Holmes. It's tolerable, but nothing you would seek out. As you watch his receding back, a Blackberry already lifted to his ear, you realise how grateful you'd been for the company, the distraction. Now, all you can do is watch the numbers and graphs flickering on the laptop screen. It's an artificial, temporary death conveyed in ones and zeros, and all you can do is bear witness.

**Notes for the Chapter:**

> CCU = cardiac care/coronary care/critical care unit, depending on the hospital. Mostly it means a heart problem -focused high-dependency unit, which means a step down from intensive care.
> 
> vasoactive = an adjective which describes a medication that regulates how peripheral vasculature behaves — whether it dilates or constricts. Noradrenaline is a vasoconstrictor; it raises the systemic blood pressure by constricting blood vessels. In other words, it makes the container for the blood smaller.
> 
> milrinone and levosimendan = medications which are inotropes, meaning that they try to increase the heart’s contractility aka the ability of the heart muscle to pump
> 
> A-fib, atrial fibrillation: the heart has lost its ability to retain sinus rhythm and the atriums are contracting rapidly and chaotically while the ventricles are trying to keep up as best they can. This is not a resuscitation rhythm, but when too slow or too fast can lead to a threat for life.
> 
> BiPAP = bi-level positive airway pressure, a means of supporting a patient’s own breathing by maintaining a constantly positive airway pressure plus offering a bit of an extra kick to the patient’s own breaths. In pulmonary oedema and respiratory exhaustion, it can buy time or even spare a patient from intubation and respirator treatment.
> 
> Rising carbon dioxide levels = sufficient respiration has two components. 1. getting enough oxygen and 2. being able to expel enough carbon dioxide.
> 
> ITU = intensive treatment unit, a term used at some UK hospitals instead of Intensive Care Unit
> 
> hypnotic (drug) = medications responsible for producing the sleep part of general anaesthesia. In addition to those, analgesics (pain management meds) and often also muscle relaxants as well as some other bits and bobs are needed for GA.
> 
> cardiac bypass = machinery designed to take over circulating the patient’s blood while their heart is stopped so that surgery can be performed on it.
> 
> coagulation = the clotting of blood
> 
> clotting cascade = the chain of chemical reactions which begins with clotting factors recognising a bleed and ends with a clot that’s no longer needed dissolving
> 
> perfusion = the passage of blood through the blood vessels or other natural channels in an organ or tissue
> 
> endocarditis = microbial infection of the inner surface of the heart, most often bacterial in origin. Intravenous drug users are a big patient group because they introduce bacteria into their blood all the time, and those bugs can travel and adhere to the heart, particularly valves. Another important origin are tooth infections. See a dentist regularly and brush your teeth if you don’t want to have heart valve surgery!
> 
> to extubate = to remove an intubation tube once a patient is breathing on their own
> 
> sedation = the administration of hypnotics to keep patients calm, drowsy or in light or deep sleep, depending on their stability and their management plan. Deep sedation is usually not desirable unless high intracranial pressure warrants it. The line between very deep sedation and general anaesthesia (“sleep”) is pretty much drawn in the sand.
> 
> asystole = the heart has stopped pumping, and even the conducting system has gone silent. It’s a rhythm encountered in some cases of cardiac arrest. In this case, it is produced deliberately; it’s easier to fix a heart when it’s not pumping, and the cardiac bypass will look after Sherlock’s brain and other organs while his heart rests.


	4. Reunited

**Notes for the Chapter:**

> Medical term explanation at the end of the chapter as usual. Time to find out how the surgery went.

"In addition to the two posterior chordae which had snapped, we found two anterior cusps fused together, and there was thickening and arching towards left atrium most likely caused by the endocarditis he had years ago. Just as we suspected, based on the CT, there wasn't enough healthy tissue in the connective ring to facilitate a plasty; we had to put in an artificial valve."

You inhale sharply, forcing yourself to focus. It's three in the morning, after all, and you can't remember a day feeling as long as this one since Afghanistan. The surgeon being here, talking to you, must mean that the operation is over. This would be confirmed by the view on the laptop if you hadn't been told by Mycroft not to advertise its existence. You have to agree that people finding out these systems can be hacked would cause panic.

He's here to talk to you because the operation is over, and Sherlock has survived it. A hysterical grin splits your lips like a slash wound. You must look like a madman.

Of course, he'd pull through. Of course he would. Some heart valve doesn't get to take down Sherlock Holmes.

You raise your brows, pursing your lips to signal your colleague to continue. Usually, when discussing such things with other surgeons, you'd feel that pang of loss, the fury of the unfairness of no longer being able to do what they do because your hands and your nerves can't be trusted in the OR.

Right now, all you feel is relief and gratitude, though you know both are premature. This man's stitching skills are the only thing standing between Sherlock and death. He's not out of the woods yet. He's not out of the woods until that valve has grown into his own tissue like a tree curling around man-made structures in the forest.

"One of the snapped chordae had an enlarged, fragmented end with calcified and necrotic debris adjacent to the tip; I have to say, I'm surprised it held as long as it did. His records don't show any sign of such long-term damage; it must have developed gradually as the areas affected by the bacteria healed through scarring."

"There was no outpatient follow-up after he was discharged after the endocarditis," you say, choosing your words carefully because it would feel cruel to place the blame on Sherlock right now. "Could he… could there have been a smaller operation if this had been caught earlier?"

This might be important to explain to Mycroft. It doesn't help Sherlock's recovery in any way to get guilt imposed on him by a sibling. You're going to protect Sherlock from that.

"It's not certain that the echo findings would have warranted a CT. Perhaps he could have got away with a plasty before things scarred up, but with this amount of damage… I really can't say for certain," Alexander Cowie explains.

You make a note to remember his name, tell Sherlock to thank the man once all of this is over. He wouldn't do that on his own, but you know how great it feels to hear that your patient is doing fine after you saved them from circling the drain.

"We read through all the info on potential surgical techniques together," you hastily explain. Well, you'd read them out loud to Sherlock, who didn't even have the strength to hold up his phone, or enough breath to discuss the topic. "He was hoping for a flip-over or a transposition." You're just making conversation, your exhausted and jittery brain spouting out whatever floats to the surface.

"Like I said, there was too much old damage. We resected that tissue so that there would be less of a risk for future endocarditis. He's not an active user now, is he?"

"No, he isn't," you say sternly. Sherlock's recalcitrant behaviour as a patient is bound to strain the nerves of the staff, and you don't even want to consider how difficult things would get if there was withdrawal and rehab on the table. "How did it go? Was there any… difficulty?"

"He kept going into a-fib after we weaned him off the bypass and defibrillated. That should, however, resolve now that the massive strain on the left atrium should be gone. He doesn't have a prior history with A-fib, does he?"

"Not as far as I know." Atrial fibrillation is a rhythm with which plenty of people live for decades. It's not life-threatening unless too fast or too slow, but even with an optimal ventricular response rate, it cuts off a few dozen percent of a heart's pumping ability. It would be too much of a drop for Sherlock's standards, and he would have noticed such a thing. Probably. Unless he chose to ignore it like he always ignores everything else that he thinks is just his Transport making a racket for nothing.

"Can I–– when will you take him off the vent?" you ask.

"We'll have a sedation break after four hours if he's stable, see how that goes. He didn't have an angiography before the procedure, unlike the patients who come in for an elective valve replacement, so we used an imaging scheme yesterday on the CT to check whether his coronary arteries have calcified. We found none of that, thankfully."

"Can I see him?"

There's a strange pause as the surgeon takes in your appearance — put off by the intensity of the demand you intended to be a polite request? Made hesitant by your dishevelled appearance?

Finally, he nods. "You'll find him at the East Intensive Care Ward. Room seven, if I remember correctly what they told the anaesthesia team. Give them a few minutes to get him settled, and I'm sure you can visit. He'll still be on the ventilator, though," the surgeon warns you as though you were quite daft. As though you were not the _former_ fellow surgeon you introduced yourself as, one who should remember that open heart surgery means transport to ITU intubated and sedated. You don't feel like a surgeon right now, and it feels as though Cowie is calling you out on that inadvertently.

"John," he finally says, just as you're about to bolt towards the elevators. ' _John_ ', not ' _Mr Watson'_. _Still a surgeon_. "He's young and fit, and everything went as well as we could have expected, considering the shape he was in. It'll be a long road, but his prognosis is very good."

"Barring complications," you point out. If standard-issue reassurances are all that Cowie can offer, then you don't want anything more from him. If there are no guarantees, then you'll just have to wait and see.

"Best not to borrow trouble, eh?" Cowie asks and gives you the sort of grin you probably had when you still operated on people and had just finished a successful surgery. For a moment, life was good. For a moment, you felt powerful. That moment made up for the long hours, the gruelling scut work of a surgical trainee, the exhaustion and everything else. But it didn't last, so you needed more. Like an addict. Until there was Sherlock, and until there were cases, you couldn't find anything that would bring even a ghost of that feeling back.

You thank Cowie hastily, then hurry to the lifts, which should take you to the right ward. Getting buzzed through the entrance takes too long for you not to start shifting your feet.

"Holmes?" you ask breathlessly at the counter. "Just out of surgery?"

"Room three. Sir?" the woman manning the reception window calls out after you, "Sir, if you could give them a minute––" she rises from the chair but doesn't follow you, doesn't try to stop you because you've already stridden too far down the corridor.

Room three is on the right at the end of the hall, and the doors slide open just as you're about to slam your hand on the pressure pad controlling them. Three people in scrubs and OR hats walk out, giving you a courteous nod. Are they Sherlock's anaesthesia team? Their conversation sounds relaxed, happy — a job done? A job _well_ done? You'll want to judge for yourself.

Sherlock's bed is in a secluded corner spot by the window, for which you're grateful. Your heart clenches in your chest as you take in the sight. He's beautiful, he's always so _beautiful_ , but this isn't how he's supposed to look –– not him, not ever. Six bags of fluids and blood products are hanging from a pole, infusing into his pale form. He's covered from the waist down, a long dressing covering his entire sternum with three thick drains snake out from underneath. He's intubated, of course he is, you knew he would be, but it's still jarring because it's the most unmistakable sign that he's very poorly. Or is he? You drink in the number and graphs dancing on the monitor and on the screen of the intensive care respirator, frustrated and desperate to decipher them.

Oxygen saturation: normal on thirty percent oxygen. Normal at this stage? Blood pressure from the arterial line: fluctuating but holding steady at around his baseline. Perfect. Pulmonary arterial pressure: who the fuck cares because you have no idea what the numbers mean. Surely the normal systemic BP is a sign that he's relatively stable? Why isn't he covered with a blanket, why haven't they kept him warm, why haven't they warmed him up properly after they stopped administering the cardioplegia?

It's then you notice that there's a temperature reading on the monitor: 38,6. Slight fever. That's why he's lying there without even a blanket properly tucked up to his shoulders. There's paracetamol being infused. You tell yourself to calm down because these people know what they're doing.

A forty-something, burly woman with a focused, slight smile is adjusting an infuser pump. She turns to face you. "You must be Jo––"

"He's got a fever," you blurt out, not interested in introductions.

"It's common after a valve operation," she promises. "It's the surgery itself, plus the blood coming into contact with the bypass circuit that causes it. It's not dangerous in any way."

"So it's not an infection? Did it go alright, I mean––" you blabber idiotically, and hear his voice in your head, berating you for being a dolt, for not asking the right questions, for wasting time. You know it went well. There are no more guarantees anyone can give you. It's four a.m. and you're so relieved it's frightening.

"Yeah, Mr Cowie seemed very pleased. I'm Leah."

You try to draw a deep breath. "Sorry. Yeah, I'm John. Doctor. John Watson." You shake her hand, and her touch is firm but soft. Just what you'd want for Sherlock.

Your eyes widen as Sherlock makes a strangled sound and his shoulder convulse off the bed, his head bending back. It looks like he's trying to cough but can't. His eyes are still closed, forehead unwrinkled.

"Muscle relaxant's wearing off," Leah tells you, unfazed by what's going on. "We often need to readjust the sedation at this point." With nimble fingers she administers a bolus from an infuser pump dosing something white.

You spend an agonising minute of worrying that Sherlock will fight the tube again, that he's uncomfortable, that he's in pain, _Oh God, he's not awake is he––_

The heart rate which had climbed slightly calms down, and Sherlock is still again.

"What's he on? Propofol?" you suggest, dolefully proud of yourself for having scraped together some of your professional wits.

"Yeah, and regular doses of morphine as well as a low-dose ketamine infusion."

"Because of his history? They told you about that?" It's imperative that Leah understands that doses of opioids normally used on people will do very little for Sherlock. Or so you are convinced. So you fear.

"There's a note in his file about prior use. He's sober now, isn't he? May I call you John?"

"Yeah, of course. He hasn't used in a few years, no."

"What about alcohol?"

You know she's asking because withdrawal from alcohol can make people delirious, make them convulse, and compromise surgical results.

"No, practically never."

Leah smiles without a whit of scepticism. "That's good. Anything else I should know before I meet him properly?"

 _Where to even start?_ "He'll be… uncooperative. Doesn't like hospitals."

"Very few people do. Has he been in rehab?"

"I think so. You can ask about that when his brother arrives."

"Any other family than the two of you?"

"His parents. His brother will have contacted them."

"He's not a medical professional, is he?" Leah nods towards Sherlock.

"No, no, but he's a graduate chemist. Smart as a whip. He'll understand practically everything when he listens to doctors talking. Whatever you do, don't dumb things down for him. He'll ask if he needs something to be clarified. Don't ever underestimate what he knows."

Leah chuckles. "Good to know. It's a relief, if anything, to have a clever patient. Explaining things about intensive care can be challenging."

You bite your lip, a wave of fondness hitting you as hard as if you'd opened a door to a storm outside. "He's very sensitive. With his clothes, with his sheets, everything. He's…" you look for words with which Sherlock has never trusted you, diagnoses he has sought to conceal — or perhaps never received, though he'd likely meet the criteria.

"We'll take good care of him, John," Leah says, looking at you intently. "This is always tough on family, too. Partners, in particular." Her words are pointed but somehow tentative, as though testing a theory.

You don't correct her. You don't say _'we're not like that_ '. You don't tell her you're not gay. You're not, but that has nothing to do with Sherlock who takes boxes and rules and classifications and stereotypes and eviscerates with his words, sidesteps them with his very being — makes a mockery of the carefully guarded constructs of how people usually arrange their lives and their identities. You _are_ his partner in so many ways, and you will be his partner as he gets through this. Because he needs one. Because he's not as good as being alone as he thinks he is.

Leah goes to Sherlock's bedside, reaches out for the valves and tubes attached to a panel clipped onto the IV pole. You watch her as she injects air into a tube, then surveys what happens on the monitor, jotting a few numbers down on a pad. Then, she reverses what she's done and leaves the tubes alone.

"Wedge pressure," she explains. "I assume you're not a cardiothoracic surgeon?"

"Trauma surgeon. Former."

"I inflated a balloon in a smaller branch of his pulmonary artery."

"Estimating left atrial pressure?" you suggest. You know that much.

"Yes." Leah types the numbers onto the computer on a side table. "It's within the normal range."

"What about the rest?"

"It all looks okay." She focuses on something on the computer after glancing at the monitor.

You feel like you've outstayed your welcome in quizzing her and decide you shouldn't delay what you feel oddly apprehensive about doing — approaching the bed. You don't know what to do, how to touch Sherlock, or whether he'd even welcome it. He's in no shape to give consent, but you feel a pressing need to signal that you're here like you promised, that he's not alone in this strange and frightening place you know he would abhor. You've heard ITU nurses talking to patients even when they're sedated, because who knows what they can really register and understand? You can't imagine Mycroft being very comforting or physically fraternal towards him, not even now. That's not the Holmes way. That was never the Watson way, either, but you want to do better by Sherlock, and you know it has to be you.

You reach for his hand, those long violinist fingers, and give them a squeeze. "Hi," you whisper, your thumb stroking his knuckles. "Just rest, Sherlock."

You glance at the monitors. Until now, there's been a steady stream of occasional extrasystolic beats of varying kinds — a combination of the side effects of medications and his heart's conducting system slowly recovering from the shock of being first halted and then electrocuted back to life. It's ridiculous that every drug used to treat arrhythmias can also produce them.

As you hold his hand, those erratic beats recede, leaving nothing but a steady sinus rhythm, heart rate low but not bradycardic.

You lean closer to make sure and find relief in how his eyes are not shifting under nearly translucent, delicate lids. He's calm. He's resting. He's not in pain.

His breath stinks to high heaven.

Thankfully, Leah's already placed an emesis basin on a side table containing a toothbrush and a tiny individual pouch of paste, wet wipes and hand cream and lip balm. Sherlock's lips are cracked from breathing dry air all night and from not being able to wet them with his tongue. You remember many patients before who'd spent a long while with their mouth open because of the intubation tube. The dry air is what causes the halitosis and makes them feel as though they'd crawled, parched, across the Sahara.

Sherlock's hair is tucked inside what looks like a tinfoil-covered shower cap, but of course a few of his unruly curls have slipped out.

"We can take that off, now," Leah says when she sees your gaze fixed on it. "It was just to help warm him up. He went straight up to spiking a fever, but I guess they were in a hurry to transport and didn't take the hat off."

You're half-convinced that, out of all the mortifications of being hospitalised, Sherlock would probably think this hat is the worst. Leah reaches out for it, but you get there first, gently prying it out from under the back of his head. You do the best you can to arrange his hair, but it's been tousled and flattened by the hat and by being lying down all day and night long. Half-covered under a dressing, you see the large central line jutting out of his neck. Connected into it is the Swan-Ganz catheter for all those measurements you wish you'd understand better, and so many tubes of fluids and medications that it looks like someone has poured a small kettle of translucent spaghetti onto the mattress next to his head.

Leah is drawing blood samples from the arterial line. "Mr Cowie authorised a sedation break in four hours to see how he does. That's assuming he remains stable, of course. The cardiothoracic anaesthetist on call will do an ultrasound before that with the oesophageal probe they used in the OR," Leah explains.

You doubt she'd volunteer so many details to a non-medical family member.

She nods towards the windowsill; there, what looks like an unusually thick gastroscope is wrapped in plastic. "I'm sure you can watch the exam, hear how the valve is doing. If the anaesthetist gives the all-clear and Sherlock's haemodynamics look fine during that sedation break, we can move onto extubation."

You try to avert your eyes, but you're still staring at the thick, black ultrasound probe. You know Sherlock will be sedated when it's put to use again; you know the exam won't hurt and he won't be very uncomfortable, but it's still all just wrong. He was fine this morning. He was standing in Lestrade's office at NSY ranting about body decay rates and metal alloys. That was Sherlock. That _is_ Sherlock, not this. Not like this, silent on a bed tethered to a hundred wires and his heart sewn back together.

"Where's the––" you start, your voice strangled and black dots dancing at the edges of your vision. You haven't eaten or drank anything in God-knows-how-many hours.

Leah cocks her head towards the hall. "First door on the left."

Your name is Doctor John Hamish Watson, trauma surgeon and veteran of Kandahar and Helmand and Barts bloody hospital, and now you're in the small visitor toilet, staring at your own haggard visage in the mirror after sticking your head between your knees while sitting down for a moment. Your vision clears. Your duty calls.

You never were any good at this, when it's family. The sinking feeling of being a failure of a doctor in such a manner as well as weak, weak, _weak_ , _pathetic_ –– your father's words, forever etched into his tombstone inside whatever passes for your version of a Mind Palace. Memories are places in the mind, and you'd give anything to not give the vision of Sherlock in that ITU bed permanent residence.

You don't understand yourself. You don't understand Sherlock, or the strange and instantly irreversible and pathologically entangled relationship you built him right at the start, with those very first words he spoke to you. He read your military history in your posture and burnt himself into your soul just by looking at you.

It's different from when your Mum died. It's different from when Grandad died. It's different, because Sherlock chose you and you chose him and no words to that effect even need to be exchanged to confirm what you've both known instinctually.

You really need to stop dating other people.

He needs you. You can do this. He always pushes himself one more bit beyond normal endurance, that one step beyond normal in every way. You have no idea how he'd react if your roles were reversed. You don't care. People think he doesn't feel things, that he has no empathy. Fuck them. They don't know Sherlock at all.

**Notes for the Chapter:**

> CT = computer tomography; a type of x-ray imaging based on doing tons of x-ray slides which are then stacked together by a computer to create images
> 
> mitral plasty = a general procedure type in which the mitral valve is repaired, not replaced. Flip-over and transposition are subtypes of this.
> 
> necrotic = dead
> 
> cusp = the mitral valve consists of several cusps aka leaflets
> 
> to reset = to partially remove
> 
> defibrillation = using electricity to revert a heart’s rhythm into normal
> 
> cardioplegia = pharmacological means of deliberately arresting the heart for surgery; potassium-containing solutions are a common substance used
> 
> angiography = imaging of vascular structures using contrast medium and guidewires advanced into those structures. Can be used to study brain vasculature, coronary vasculature or other areas of the body to find and treat aneurysms, clots and stenosis (narrowing).
> 
> ventilator = roughly the same as a respirator; “a breathing machine”
> 
> drain = tube left in after surgery to drain blood and other liquids out from the surgical site. If a drain starts bleeding excessively it can be a sign of a complication.
> 
> blood products = these days whole blood is a rare means of administering these to a patient — we mostly use blood components (fresh-frozen plasma, red blood cells, fibrinogen, platelets and specialised concentrates of different clotting factors) according to individuals needs.
> 
> muscle relaxant = a type of drug used to facilitate intubating patients and to allow surgeons to operate on organs without the patient’s muscle tone making things technically challenging
> 
> propofol = common intravenous anaesthesia drug which is a hypnotic — meaning it produces sleep. It doesn’t affect pain much, so for surgery, a nerve block or opiates are used to manage that part of general anaesthesia.
> 
> pulmonary artery wedge pressure = a way of indirectly assessing the filling pressures of the left atrium
> 
> cardiothoracic = having to do with the heart and the chest cavity
> 
> bradycardia = abnormally slow heart rate
> 
> bad breath after anaesthesia: true. Can be hideous. Anaesthesia ventilators don’t provide moisture into the breathing circuit, so the air the patient breathes is dry and affects adversely the patient’s ability to remove debris from their airways through ciliary action (tiny hairs making snot travel around). Plus the patient will spend hours with their mouth open because of the intubation tube. All of this affects bacterial growth in the mouth and salivary production.
> 
> oesophageal cardiac ultrasound = gives a much clearer view of certain heart structures since the bony thoracic cavity isn’t in the way. It can be done to sedated, awake patients, but it is not pleasant. In cardiac anaesthesia it is used during and after surgery once general anaesthesia is induced to assess heart function before and after the surgical repairs.
> 
> haemodynamics = the dynamics of blood flow and circulation. We speak of haemodynamically stable patients when their heart rate, BP and such are within acceptable parametres and unstable when they’re not.
> 
> extubation = removal of intubation tube. It’s best to give just-out-of-the-OR cardiac surgery patients some time on the vent under sedation because it spares their own energy reserves and prevents the heart getting stressed out by pain and anxiety hormones and spares it from having to meet the needs of an awake body before its function has stabilised enough.


	5. Welcome Back

**Notes for the Chapter:**

> You know the drill — pertinent medical terms are explained at the end of the chapter.

The anaesthetist is delayed, and consequently so is the ultrasound exam. You've kept Mycroft updated via texts and calls, and at four in the morning he walks into the ITU, listens quietly as you introduce all the equipment and give him a report on what's been going on. He looks unburdened by the ungodly hour, on which you comment sarcastically. He replies in a matter-of-fact tone that there are developments in the Middle East which have detained him and kept him alert.

"And he is merely sedated? There is no reason to assume the cardiac arrest would have compromised cerebral function?" he asks once you think you've covered much more than just the basics.

"They used what's known as INVOS to monitor brain circulation. I don't know how precise it is, but the internist told me they saw no dips in the readings."

"I doubt their parameters are very well suited for the likes of us," Mycroft says coldly. Perhaps he is on the edge — it's hard to tell with him, unlike with Sherlock, who rarely conceals emotions unless he thinks they're making him look vulnerable. Anger, exasperation, arrogance — those are all displayed freely because they're an offence rather than defence.

"Just sedated," you confirm, hoping that the conversation is concluded.

The rational part of you knows that there is no harm in allowing Sherlock's artificial slumber to last a bit longer; it gives his body peace and quiet to heal itself. You still can't help wanting to see him, talk to him, make sure he's alright. You long to ask what he remembers and how it was in theatre before they put him under. You want to explain things to him, to make it all more palatable and less upsetting. You recognise that the possessive protectiveness you feel for him had made you even irrationally suspicious of Leah until you had observed her work. Now, you trust her, because you've enough to recognise that she is very good and experienced at what she does, and that she treats her patients gently and conscientiously.

"So far, so good, all things considered?" Mycroft summarises.

"I'd say that's a fair assessment, yes."

This is Sherlock Holmes — a man who would bounce back from anything even if just to spite those who might have given him a more precarious prognosis. You should have had more faith in him.

Mycroft doesn't ask further questions, doesn't approach the bed. He stands, posture regal and a bit stiff, looking almost endearingly human with the wrinkles in his clothes and the mask of commanding indifference which keeps slipping in increments as he watches his baby brother on a ventilator. You wonder how long he's worn this suit — perhaps all the way from South Korea or at least as long as these… developments have gone on. Did he go home, or has he been commuting between the hospital and Vauxhall Cross since he was informed that Sherlock had been brought here?

The room doors slide open and a woman roughly your age — who turns out to be the cardiothoracic anaesthetist on call — pushes in a large ultrasound machine.

Finally.

Mycroft steps out into the hall while the exam is done; you stay in, telling yourself it's penance for your minor breakdown in the loo earlier that you must watch and stay composed. Sherlock remains lost to the world while his heart is imaged from many angles, colourful puffs of Doppler showing only minor leaks at the seams of the new valve ring. You manage to appreciate how the oesophageal probe gives a much sharper, more detailed image than the transthoracic one, since the cage of the chest wall isn't in the way.

You recall what his old, catastrophically leaky one had looked like when Mike had inspected it. Now, blood pushed by the atrium into the left ventricle stays there until it is ejected through the aortic valve into the aorta. Without a pathological backflow, Sherlock can maintain his own blood pressure once his heart recovers from the shock of surgery and sheds the remains of dysfunction. There are still signs of pulmonary congestion on the chest x-ray taken with a portable machine after the ultrasound is concluded, but that's to be expected. At least the oedema is less pronounced, nor have the crescents of pleural fluid increased. Diuretics are infusing to get rid of the extra fluid accumulated where it doesn't belong. The internist who pops in to summarise the x-ray findings and what the anaesthetist had reported to him says they'll continue levosimendan for twelve more hours to support the heart as it adapts back to normal systolic function.

Though you know both Holmeses would abhor it, you love that word right now — _normal_. It's nothing people would usually employ to describe Sherlock, but right now, it's precisely what you want him to be: _normal_ in every physical respect for someone who's just had major surgery on their heart. He can't be exceptional yet, and perhaps having undergone a bypass operation will have lasting residual effects, but normal is plenty enough for now. _He's not quite there yet_ , you remind yourself, _but he's on his way_.

_____________

Leah explains that they try not to go through care routines or make big alterations just before or during the shift handovers, so Sherlock's sedation break and potential extubation will have to wait until the morning physicians' round is over. He's now on his side with large supportive pillows keeping him in place; Leah had turned him with the help of two other nurses in the early hours of the morning. You're aware that changing positions is important for preventing bed sores and clots and for respiratory health, but in your sleep-deprived state, it had felt disconcerting to watch him be rearranged like a rag doll.

The heparin which had made his blood practically uncoagulable during surgery has been reversed. There will be a regime of other anticoagulants introduced into Sherlock's medications, but due to having been on bypass he's at high risk for clots so he has pump socks on which help prevent blood from pooling in his legs before the first medications kick in and he's capable of taking tablets.

Leah discreetly inquires the rounding staff whether John, since he is also a doctor, is allowed to be present during the discussion of Sherlock's case. Permission is granted with a polite nod and smile from the chief of the unit leading the round.

A registrar assigned to Sherlock's case who'd introduced herself just before the round presents a summary: "Sherlock Holmes, thirty-five years old. No regular medications or long-term somatic diagnoses prior to hospitalisation. Sporadic smoker, allergic to sulphonamide antibiotics, social alcohol use, no current drug use. There's a history of endocarditis from six years ago, secondary to intravenous use of cocaine and heroin. No significant valve pathology detected then, no compliance to follow-up. Presented yesterday with rapidly developing acute heart failure caused by rupture of mitral chordae. Classification severe, NYHA class IV, pulmonary oedema and hypotension present at admission. Surgical correction late last night through standard open sternotomy with a bi-leaflet disc mechanic replacement valve. Minimal seam leak within accepted post-operative parameters, ultrasound already showing marked improvement in ejection fraction and thoracic x-ray showing resolution of oedema."

The unit's chief physician nods. "What do you propose as the treatment goals for today?"

"Continuation of inotropes until the afternoon, standard weaning off protocol applied promptly if haemodynamics continue to permit it, initiation of warfarin therapy with small molecular weight heparin bridging."

"Very good. Have we got any questions?" The chief turns. "Doctor Watson?"

"No, I'm… he's doing well," you conclude. "We can get him off the vent?"

"Indeed."

The entourage moves on to the next patient — a sixty-something woman who has undergone a triple coronary bypass and is not doing well at all. She's very obese and her cardiac function has been compromised by two previous infarctions and obstructive pulmonary disease. In a room of four patients, it's impossible for visitors to avoid overhearing things about other cases. At least no visitors else besides you have been present when Sherlock's drug history has been discussed. It's nobody's business, and you don't want people to look at him with open judgment on their faces. He gets enough of that with the Met.

_____________  
  
  


The day shift nurse is called Andrew. He's a quiet sort, which Sherlock will probably appreciate once he's awake. Andrew attends to his duties with diligent, calm focus, and makes you feel less like an intruder than having Leah around did. Andrew seems to have an infinite amount of patience for your questions, which someone with less professional confidence might take for distrust in their meticulousness.

You watch him halve the rate of the propofol infusion. "Has he had his pain meds?"

"The ketamine's been discontinued, but I'll give him some oxy once he starts triggering the vent to see if five milligrams will depress his breathing or not and to make extubation less uncomfortable. There's also the regularly administered paracetamol, plus we can always go back on sedation if he doesn't seem to be tolerating waking up just yet. You alright?"

You wonder what has prompted the question. A yawn makes itself known; you're overtired, but if you tried to sleep you probably couldn't. Not until you talk to him. Not until he looks at you, really _looks_ at you, and recognises you. Not until you know he's safe. "I'm fine."

"Might take a while. Maybe you want to go have a bit of a rest? The sofa in the family room's not too bad."

"Will you come get me when he starts waking up?" you ask, worried that you'll miss the moment, worried Sherlock will have to come to without a familiar face greeting him.

"I promise," Andrew replies confidently. "He needs your energy since he won't have any."

"You see this all the time," you ask, "what's it going to be like for him?"

"Sore throat, sore everywhere. Probably a bit of a cough since his notes say he had one before, and that's going to hurt with the sternotomy. Out of breath, and he's going to need enough meds that his breathing will be so-so for some time. We need to get him to do some breathing exercises early on, and he won't like them. Might need some time on BiPAP depending on how quick he drains the lung fluid."

"Believe me: he's going to hate everything about this, not just the breathing exercises."

"Best rest and regroup a bit, then, eh?"

Reluctantly, you glance at the ventilator's monitor screen and see that Sherlock isn't doing anything on his own just yet; the breaths visible on the graph are all machine-produced. You bite your tongue to keep from asking one more time for Andrew to _please_ find you the minute there are signs of independent life from the still form on the bed.

_____________

Resolute to find solace in Andrew's promises, you manage to nod off as you sink into the old, soft sofa. Your body is so confused by the battering it's taken in the last twenty-four hours that, when you wake up to someone shaking your shoulder, you have no idea whether you have slept for six minutes or six hours. Your limbs are as heavy as your lids, and you're cold, chilled down to the bone. This is how you always felt when jolting awake to the sound of the phone when you were on call as a trainee surgeon. There is a sense of illness and decay that clings to you like cold sweat, and the last thing you want to do is uncoil from your makeshift bed and face whatever is intruding on much-needed rest.

The messenger is Mycroft, not Andrew. You assume the older Holmes doesn't have any news — just wants to be the pest of a man he can be at his worst.

"They've only started weaning him off," you mutter.

"Andrew informed me that you wished to be present when he began showing signs of taking over breathing on his own. He's now done that — and more — within the last ten minutes."

You bolt up to a sitting position, reality finally pushing away your dreamscape. "What do you mean, ' _and more_ '?"

"We should get back to his room. I could have some fresh clothes for you and some of Sherlock's belongings delivered here?" Mycroft suggests, crinkling his nose at your appearance. The bastard looks like he's posing for the centrefold of Horse and Hound magazine.

You hardly care about Sherlock's posh aftershave or a fresh pair of boxers right now. The man's priorities are shite, you decide and jut your chin up defiantly at him. You shove the shirt which has slipped out from under the waist of your trousers while half-jogging back to Sherlock's room.

Andrew, with his back to the door, has leaned over the bed and is talking quietly. Once you get closer, you can see he's trying to pry Sherlock's fingers off the bed rail, which they are squeezing so hard his knuckles are blanched. Sherlock has been turned onto his back again, and the respirator has been changed to CPAP mode — no enforced breaths by the machine, just a bit of constant pressure support so that Sherlock's lung sacks won't collapse from the supplementary oxygen and shallow breathing. Not that the gulps of air he's taking through the tube appear very shallow — they're noisy and he's working hard, chest heaving and neck muscles retracting. Andrew's reflexes are barely enough to grab his other wrist when his hand suddenly reaches for the intubation tube, still taped in place.

"Took him not fifteen minutes to start coming round once I shut off the propofol completely," Andrew says, and he only sounds half-surprised. You wonder what of your rambling explanations about how Sherlock is not like most people Leah had conveyed to him.

When Sherlock finally stops struggling in his grip, Andrew steps back, lets you take over. "I'll call the respiratory therapist and his ITU doc. I think we can extubate."

"Is he well enough?" Mycroft inquires.

"Yeah. BP's a bit on the high side, but it would be the opposite that would worry us more."

Andrew lingers a bit, wary of any attempt by Sherlock to try to rid himself of the tube. Thankfully, he doesn't try to grab it again. You wouldn't let him, anyway — you rest gentle palms on his shoulders, just to tell him you're there, hoping he can tell your hands apart from those of others. He seems to settle, eyes still closed but eyes shifting beneath almost translucent lids. The softer tapes which had kept his eyes closed during surgery to prevent his corneas from drying were removed shortly after arrival at the ITU. He has dark shadows under his eyes and his complexion is pallid.

Andrew returns mere minutes later. Sherlock coughs, gags a little as Andrew uses the suction to make sure he doesn't wake up with a mouth full of saliva. Once the respiratory therapist arrives, with the junior doctor you saw earlier in tow, the tapes holding the tube in place are pried off.

Then, gathered around the bed, you wait. Andrew gives you a nod and you lean closer. "Sherlock? Are you awake?"

You know that an intubation tube can be bothersome even to someone who's unconscious. You know that the sedation might still linger enough that he could fall back asleep.

You just want him with you. You just want him back.

A shudder travels down his form and then he frowns and starts to cough, his hand shooting up towards the tube again.

Andrew's eyes fix on the registrar who nods quickly. "Let's pull the tube," the doctor authorises. "I think he's surfaced well enough."

The respiratory therapist disconnects the ventilator tubing; Sherlock is now breathing completely on his own without pressure support. An oxygen mask is readied, the air cuff of the intubation tube emptied. This brings forth a violent coughing fit and a wet groan, and the monitor begins warning of tachycardia.

There's a pause in Sherlock's breathing after the tube is removed; patients' vocal cords often react a bit to extubation, causing temporary obstruction. Sherlock tries to push away the oxygen mask, struggles a little when you grab his uncoordinated hands and keep them still on the bed. You feel a bit self-conscious to talk to him now that he can hear you and so can the others, but he needs to know you're here, needs to know it's safe to come back.

"Sherlock? Can you open your eyes?" you prompt, glancing at the monitor before your eyes dart back to him.

He's still tachycardic, blood pressure fluctuating a bit. Saturation perfect. He clearly hates the mask, tries to pull it off, even tries to sit up with his eyes still closed, then collapses back onto the mattress with a long, agonised groan of pain. He tries to push your hands away, grimaces as the effort of trying to turn to his side on the bed strains his chest wound.

You quickly shift to the opposite side of the bed, lean closer and rest a palm on his cheek. "Sherlock? Eyes open, please. It'll all make more sense if you do."

He mutters something under the hiss of the oxygen mask, then his lids start fluttering open. His eyes are unfocused, drifting from one side to another, not settling on anything.

"Surgery's done. You're fine. You're at the ICU. Mycroft's here, too," you tell him, glancing quickly towards the still figure standing by the curtains separating Sherlock's space from his neighbour's.

Sherlock coughs a bit, flops back onto his back. Any movement he initiates seems to be causing him pain judging by his heart hate and the way his features scrunch up and his breathing hitches.

Andrew watches patiently, nods to the doctor and the respiratory therapist who readjusts the oxygen flow in the mask a bit lower. The two of them then leave after instructing blood gases to be drawn from the arterial line in fifteen minutes.

"Good morning," Mycroft says to his brother. He has now come a bit closer, but allows you to commandeer the immediate territory of the bed. "Can you tell us how you're feeling?" he prompts his brother.

You don't know what you expected Sherlock's first understandable word to be, but surely it can't have been ' _lighter'_? His tone is surprisingly energetic and insistent, considering he's just had open heart surgery.

"Did you say… lighter?" you repeat, dumbfounded. He often leaves you confused and you love him for it. It tends to be evidence of the brilliance which draws you in like a moth to a flame. Right now, though, you're not so certain it's a sign of much intelligence.

"Smoke, Jhn," he slurs and tries to turn to his side again, eyes glassy and dazed. You shove an arm in so that he can't change his position too much — the three drains coming out of his chest and the various monitoring cables could get tangled or dislodged.

"You can't smoke right now," you tell him.

His forehead scrunches up and his lips part a bit under the transparent mask. "John?"

"Yeah," you confirm, trying to sound nonchalant when you want to pump your fist in the air.

"Why?"

"Why what?"

"Lighter, John," he demands again, but his word lack his initial insistence.

"You can't smoke right now. You've had surgery, remember?"

"Can't smoke aft… srger _why_?"

"Because this place is full of oxygen and you'd probably blow a big hole in the wall," you suggest, astonished at the fact that he's barely out of the propofol infusion and already arguing with you. You've seen this before, though. After general anaesthesia to fix an ankle fracture after he'd refused a spinal block led to such a rapid emergence after being carted to the recovery room that he managed to fall out of bed. Thankfully, the ankle wasn't broken a second time. Mycroft had threatened to sue, though you're not sure who. Possibly Sherlock, for giving his big brother yet another scare.

You glance at Mycroft, whose eyes are narrowed as he is surveying the rest of the room. "Sherlock having a roommate is not conducive to either of their recoveries," he remarks dryly.

Mycroft is good in a crisis. He organises things. Remains calm and collected. Except when he's not. The signs are subtle, but you know him well enough to be able to tell. Just like when he'd first come in and received the news. Anger is his default for when he doesn't know how the hell else to react. When he can't fix the obvious, he starts micromanaging what he can.

You ignore him for now.

"Do you remember where you are?" you ask Sherlock, who's going a bit cross-eyed examining all the wires attached to him.

He touches with his fingertips the thick plastic drains snaking out from underneath a dressing in the middle of his chest.

"London?" he tries. He starts prying off the edge of the dressing on his sternum, and you stop him by enclosing his hands briefly in your own.

"Nope," you say, "you don't want mediastinitis on top of everything because you couldn't keep your grubby paws off the incision. Can we try that question again? Do you remember where you are?"

"Gates of hell, since the guardian is standing right there," he says, nodding towards Mycroft.

Suddenly, Sherlock searches for your eyes, bewildered. The agitated restlessness seems to drain out as you watch his expression shift from purposeful to surprised. "John?"

"Yeah?" you offer eagerly, leaning forward after glancing at Mycroft, who seems ready to rise to his feet.

"What's going on? Why _is_ he here?" Sherlock cocks his head towards Mycroft.

"It's early Thursday morning. You had surgery yesterday for a leaking mitral valve. They let you sleep until things stabilised."

"Things, what _things_?"

"You've been sedated," Mycroft says patiently. "Your memory isn't working normally."

Sherlock scoffs. "Obvious. It's been tampered with."

Your lip quirks up. Sherlock would never admit to his brother not knowing something or not being well-appraised of the situation. You can sense his irritation rising, and you know that the minute he starts thinking you and Mycroft are in cahoots and keeping secrets, he'll stop trusting what you tell him.

"It got pretty bad yesterday — a tendon in your heart snapped and you went into cardiac dysfunction. You had surgery for that in the evening. They wanted to make sure your blood pressure and heart function were stable before they let you wake up," you explain.

"And where were you?" Sherlock demands. It's hard to make out some of his words from behind the oxygen mask.

"I've been here, with you, ever since they brough you in from theatre. How do you feel?"

You glance at the monitors. Very few extrasystolic beats, systolic blood pressure well above a hundred with a minimal noradrenaline infusion. The levosimendan is still infusing, but the milrinone has been stopped. Sherlock is young and his heart is in good condition. An older, frailer individual would probably not be demanding a cigarette at this stage.

 _He's still sick_ , you remind yourself. _It'll be a long road back to normal_.

"Good morning, Mister Holmes. I'd be curious to hear the answer, too," the morning shift nurse, Emma, has appeared by the bed.

Sherlock rolls his eyes. "God, you lot do so love inane questions."

"Any pain?" Emma asks. "Your heart rate's a bit fast."

"He's a bit confused," you offer, grimacing because you know Sherlock won't like being described in such a manner.

"I'm not _confused_ ––" Sherlock starts arguing as expected, but then coughs and gasps, eyes pinching shut. A trickle of blood runs down the inside of one of the drains — not an alarming amount and probably caused by the coughing raising intrathoracic pressure, but it's still blood. When Sherlock opens his eyes again, he's left staring at the drain, alarmed.

"Might need a bit more pain meds now that the sedation's stopped and you're going to be more active," Emma suggests.

"Well, what are you waiting for, then?" Sherlock snarls.

His right hand, the one without a pulse oximeter clip and an arterial line, clenches into a fist. He's got a bit ashen in the face, but the saturation reading on the monitor is still fine. He reaches up to try to pry off the oxygen mask again, and you stop him.

You're tempted to remind Sherlock that it's important to be honest about pain levels — badly treated acute post-operative pain is a risk factor for long-term pain problems. It's just that he's got a history, the kind that you know also predisposes him to drug-seeking behaviour. Any self-assessment of pain levels from a patient is subjective at best, but there are no objective measurements of pain that can be done bedside. You'll have to take his word for it, in the context of what you see on the monitors.

Emma has stepped out, hopefully to fetch some morphine or whatever they've decided to offer.

"I'm not confused," Sherlock tells you indignantly. " _You_ try waking up in this hellhole with things sticking out of your chest."

  
  


**Notes for the Chapter:**

> The Doppler phenomenon = the frequency of ultrasound signals is altered by whether they are becoming more distant or coming closer to the observer. An ambulance’s sound changing as it gains distance from the listener is a good example. The Doppler phenomenon is used to image the direction of blood flow inside blood vessels and the heart.
> 
> transthoracic = a transthoracic ultrasound probe is a surface one used on the patient’s chest as opposed to an oesophageal probe
> 
> oedema = congestion
> 
> diuretics = medications which draw fluid out of the patient into the urine and often lower their BP as a result
> 
> levosimendan = a drug that makes the heart muscle more sensitive to calcium and consequently causes it to pump harder
> 
> systole = the phase of the heart where the ventricles contract. There is also what’s known as _atrial_ systole, but let’s not get in too deep here LOL
> 
> sedation breaks = continuing deep sedation for a long time is not as conducive to a patient’s recovery as periodically lightening their sedation. Sedation breaks are thus done routinely to assess neurological function and to promote autonomous breathing if the patient is stable enough for them. For very unstable patients it’s safest to keep them deeply sedated and let the respirator breathe for them.
> 
> position changes = ensure, among other things, that there are no bedsores, that all parts of the lungs get periodic filling with both breath and blood, and that muscles get some work
> 
> anticoagulants = drugs which make blood less prone to clotting by affecting clotting factors. If they affect platelets, the specific term antithrombotic drug is sometimes used.
> 
> somatic = as pertaining to the body
> 
> intravenous drug use = to shoot up
> 
> pathology = a study of abnormal things in the body
> 
> NYHA class = a classification used in assessing the severity of heart failure symptoms
> 
> hypotension = low BP
> 
> ejection fraction = how large an amount of the blood arriving in the left ventricle can it pump out
> 
> open sternotomy = an open surgery in which the chest is opened in the middle
> 
> warfarin, small molecular weight heparin = types of anticoagulants
> 
> oxy = oxycodone, a strong opioid analogous to morphine but has a better ratio of absorption in different administration forms and causes less hallucinations
> 
> to trigger a vent = when the patient starts taking breaths on their own, the ventilator/respirator can recognise those breaths and assist them
> 
> breathing exercises after being on the respirator = artificial ventilation is never as good as real, physiological breathing in keeping those alveoli (lung sacks) inflated and ready to exchange gases (oxygen and carbon dioxide). Breathing exercises are done with patients to re-open alveoli and to keep them open. Breathing high percentages of oxygen will also cause atelectasis (collapse of alveoli).
> 
> CPAP = continuous positive airway pressure
> 
> air cuff = most intubation tubes have these: they protect the lungs from blood and vomit, keep the tube in place and prevent gases delivered by the respirator from leaking out before they reach the lungs
> 
> blood gases = what is measured with these modern analysers is much more than just carbon dioxide and oxygen levels in the blood. Usually, they also give you the blood pH, lactate level, electrolytes and other things which can help you assess how the patient is doing. We use the blood gas levels to find the right settings for the patient’s respirator and before and after intubation they’re used to judge whether they are able to breathe satisfactorily on their own or if they need respiratory support.
> 
> spinal block = regional anaesthetic technique where a dose of local anaesthetic drug is injected into the cerebrospinal fluid at the level of the patient’s lumbar vertebrae. Sedation is often combined with this but not GA.
> 
> drains = tubes used to remove pus, blood or other substances produced by the body from a surgical site. They’re also useful for monitoring for potential bleeds.
> 
> milrinone = another drug which helps the heart muscle pump more effectively
> 
> I often attach graphics such as this to my chapter announcements on Tumblr. If you want to keep up with all of my fic-related endeavours — including these visuals — follow me on Tumblr or send me your email address at baillierj [thatonesymbol] gmail.com; I have an email announcement list for all new developments (including my fic-related videocast series). Your email address won't be visible to other subscribers. I can't tag more people than I already do at Tumblr because the system only allows a very low number of functional tags per post; even if you add more the rest won't trigger an email announcement.


	6. Fluctuations

Relief summons bone-weariness, and Mycroft says he's arranged a full day relieved of his work duties, so you wrench yourself away from Sherlock's bedside for a nap at home. It's hardly surprising that it's not an easy feat — you spent the first hour at Baker Street just flitting about the flat, trying to pack this and that for Sherlock and yourself, achieving little.

You pour yourself two fingers of whisky as a mid-morning nightcap. You know it's not a good habit, this, anaesthetising yourself in order to rest, and you've done it before. You did it lots after being invalided home, before you met Sherlock. Those glasses of whisky brought with them more depression, more nightmares, more disgusting, sweat-clingy sheets and lessened your will to live, but what else did you have?

The antidepressants and the benzodiazepines you refused to touch, save for the latter on particularly difficult days. Double standard, that's what it was, convincing yourself alcohol was less dangerous. Less addictive. You know it runs in your blood, the risk. Harry's embraced it with her arms open. Your father died of it.

You're just about to switch off the lights in the kitchen, when there are steps in the stairwell.

"John?" Mrs Hudson calls out after opening the door. You never lock it, nor does Sherlock.

"Hi," you say tiredly. She is never a nuisance, but you're not in the mood for polite conversation.

"Where's Sherlock? Where have you been?"

You wonder if she has some kind of sixth sense, because she should be used to long absences of her tenants by now. She looks concerned, demands answers with her stern schoolmistress' gaze.

You realise she doesn't know. To you, she's more than a landlady but still a landlady; to Sherlock, she is clearly a dear friend. You secretly enjoy watching them interact; Sherlock never speaks of her with the exasperation reserved for his parents. From her, he allows such open caring and mollycoddling you doubt he'd welcome from anyone else. She's a chosen surrogate parent, someone who sees him, _all_ of him, and accepts it, warts and all. You know she's seen Sherlock at his worst; hints picked up from conversation and from Mycroft have helped put together a rickety puzzle of the life Sherlock had been leading when he'd wound up in Florida.

She deserves to be kept up to date. "Sherlock's in hospital."

This gives her pause. "Oh, dear. What for? Did he get stabbed again?"

"What do you mean, _'agai_ '–– nevermind. He's got a heart issue; had surgery for it yesterday."

She enters the flat, shoulders tucked back. In battle mode, not defeated in shock. "That sounds awfully serious! How is he? Will he be alright?"

"He's awake and complaining." You both know this is a sign of a baseline mental state returning.

"It wasn't a heart attack, was it?"

"Not the usual sort, no. He's got — he _had_ a faulty valve which needed replacing. Got a bit touch-and-go, but he's pulled through."

"But was there something he should have noticed, or… oh, that boy is so dreadful at looking after himself. He's lucky to have you."

"And you." The words barely make it out before a yawn splits your face.

"I should visit." She heads resolutely for Sherlock's notepad on the kitchen table. "What hospital and which ward?"

You don't have the heart to tell her only family members are allowed. After all, what are you? It occurs to you that Mycroft can probably wave his magic bureaucratic wand and get her permission. You also wouldn't put it past Sherlock to lie that she's his mother. You're convinced she'd welcome her rather than his actual parents. You can't quite put your finger on what Sherlock thinks of them. Adult children and parents — always complicated. That's what you assume, anyway — you buried yours before the age of twenty.

"Hammersmith, East Intensive Care. I'll let you know when they move him to another ward."

"Intensive care?" she asks, frowning.

"That's standard after cardiac surgery," you reassure her. "I'll ask the nurses when it would be convenient for you to come."

"Thank you, John. Won't you give him my love? Should I send in some food with you?"

"I'm not sure he'll be eating much yet. Not today, probably."

You realise how little you know about the immediate recovery from such surgery. What you do know is that he's a picky eater and will probably crinkle his nose at the gastronomic offerings of the hospital. "Maybe tomorrow," you tell her. "He needs to rebuild his strength."

She looks utterly delighted; you can practically see her thoughts reverting instantly to a massive index of memorised recipes so that he could spoil the strange person she has adopted so determinedly. You have a strong hunch that from her, Sherlock just might allow the kind of consolation he would be embarrassed to receive from you. The thought makes you uneasy, because you _want_ to be the one to give it. It's preposterous, really — the two of you don't act like that at home, when things are normal. But when something's wrong it's… when you were bedridden with just some pedestrian head cold, Sherlock was concerned — genuinely so. And tried, in his fumbling way, to make you feel better. He even cooked, but neither of you ever wants to revisit the memory of the results of that attempt in terms of taste. He tried, and he never makes such an effort for anyone, save for this woman and you.

"Will you be going back to the hospital today?" Mrs Hudson asks, and something in her tone signals that there is only one right answer.

"Yeah, once I get some sleep. Haven't had much of that in the past two days."

"Of course. I'll leave you to it. Pop in on your way out; I'm sure I can rustle something up for a quick dinner. You'll need your strength, too, once he's getting on the mend."

 _Truer words were never spoken_ , you think as you head to bed.

  
_____________  
  
  


When you get back to the ICU, there's a bit of commotion going on in Sherlock's room. He's being held down by Andrew who is patiently but sternly telling him to calm down and repeating that everything is fine.

You drop the plastic bag of toiletries and clothing you're carrying on the visitor chair and get close to the bed.

"Hey?" you ask Sherlock, who's still trying to squirm.

"Woke up disoriented, trying to get rid of all the monitoring," Andrew says. "Waiting for the sedative to kick back in."

You're glad that he's doing a long shift tonight. An unfamiliar face on top of everything else would be disastrous. Then again, if Sherlock is too out of it, he might not recognise even the nurse.

"What sedative?" You know he reacts adversely to certain benzodiazepines. Mycroft knows this, too. There should be a note in Sherlock's file. You want to kick yourself by not asking Andrew to double-check.

At hearing your voice, Sherlock goes still, and his eyelids drift open slowly. "Johh--n?" he slurs. Perhaps whatever they have given him is kicking in, now.

"Some propofol, an extra dose of oxy and we started an infusion of dex. Takes some time to take effect, the last one."

You notice another nurse standing by; perhaps both of them were needed. There's also a new bandage — a thick, bulgy one — on Sherlock's wrist, and a plastic cover under that hand. You lift the edge of it and find a large, bright, bloodstain that's still wet.

"Pulled his arterial line. Doctor Mansfield will do a new one once he's calm," Andrew explains. "BPs been stable, but we still need regular bloods and there could still be some hiccups."

Thankfully, the latest blood pressure measurements done with an inflating cuff are in Sherlock's usual range: 100/78. Perfect, really, though there's still a noradrenaline infusion going into his central line. You stand by the bed, watching Sherlock just as Andrew is. His eyes are half-mast, his breathing has deepened, and Andrew finally lets go of his wrists. You wonder how big a wrestling match they've had.

"My daily exercise," Andrew jokes, and rolls his shoulders.

"Putting him back on a dex infusion… won't that delay getting transferred out?" you ask, hesitant to touch Sherlock in case it makes him stir again. If he's falling asleep, that's good. It's good but you prefer him awake and arguing with you, not knocked out by drugs. You prefer him at work on a crime scene, perched on the backrest of his chair or adjusting his microscope at the kitchen table.

"Depends," Andrew says. "Can't send him to the ward in delirium."

"Surely he's not… after extubation, he couldn't remember anything, but he wasn't like that."

"He's had major surgery and his circadian rhythm is messed up," Andrew reminds you. "It's normal that patients can get a bit overwhelmed. Give him time," he says gently as though it's you who needs comforting, reminding of what has happened. "Familiar company's good. Anchoring."

Guilt stabs you in the gut — why _wouldn't_ Sherlock be confused and agitated and scared to wake up in a place he couldn't recognise, in pain, hooked up to all this equipment and strangers holding him still? Why had you gone home? It's been less than a _day_ after he got his heart stopped, for fuck's sake!

You realise you always expect him to be above it all, just like he seems convinced that no mortal problems should affect him. He's tricked even you in to believing he has superhuman strength and intelligence, which can resolve any problem in a second. Mycroft sees past all that and you should, too. It just disturbs you too much to see someone so full of life first at the brink of death and then in this state. The very thought is alien, because this is not Sherlock. This doesn't happen to Sherlock.

Andrew unravels the dressing covering the wad of gauze which has exerted pressure on the arterial puncture site. He cleans the wrist, checks that it doesn't start bleeding again, then covers it with a fresh, thin bandage.

"We don't often use restraints, but that was––" the nurse then starts with a warning tone, glancing at you as he works.

"No. Absolutely not." The words are out before you've even processed them. "I'll be here; I'll sit with him, remind him what's going on."

You're not leaving him alone again. You made that mistake once, and now he's bled all over his bedding for it. As penance, you watch Andrew and two other nurses change the sheet by gently rolling Sherlock onto his side and shoving the sheet underneath him, pulling it out the other side and then reversing the operating with a clean, crisp one. Once he's on his back again, he half-stirs and tries to turn to his side. Andrew helps him, keeping a close watch on all the wires and drains. Sherlock then tucks his hand underneath his pillow just as if he was just sleeping at home, and you can breathe easier — he's not sedated deeply enough to just lie there like a human rag doll needing to be manhandled. He's just sleeping, just as he should be.

"That's dex for you," Andrew comments with a smile. "No breathing problems, light sedation, even helps with pain. Go on," he prompts, and you are mortified by your own hesitation. "I'm positive he'll hear you if you talk to him."

When Andrew goes to shove the linens into a laundry bag, you drag the chair closer, finally alone with Sherlock. Well, as alone as one can be in a room of another patient and four nurses just behind a curtain.

You tug the blanket a bit higher so that it covers Sherlock's shoulder and rest your hand there. "Sorry I wasn't here. It'll all come back to you. We just need to give it time."

Your answer is a quiet hum and somehow, you're convinced he's heard you and understood — if not your words, then at least the reassurance within them.

_____________

The next time he floats to the surface of sedation, you're ready. You've been half-heartedly reading the novel you grabbed from the sitting room before hurrying out to hail a cab. You're registering none of the words passing through your visual field because you glance at Sherlock every few lines, battle-ready, your muscles tensing every time you hear so much as a sigh or you see his fingers twitch. He could be just dreaming, but you can't chance not being right there if he's waking up, instead.

Mycroft left after sunset, visibly comforted by the sight of Sherlock resting while you keep vigil. Mostly, when you watch him attend to his brother, unease seems to flirt with concern. You know what it's like to worry about Sherlock constantly. When he was well, it was just a hum in your bones, an invisible tether you kept taut in your mind between the two of you so you'd never be far enough to come to his aid. Now, even the oxygen mask on his face — necessary again because of the sedation — is a wall high enough between you to make you restless.

As you stretch your left arm by holding on to the raised side rail of the bed, you feel something brush against your fingers, making you flinch. You almost drop the book in your other hand when your head whips towards the bed and your eyes meet a pair the colour of the sky reflected on a stormy sea.

"Morning," you say, instantly regretting it after remembering what Andrew had said about circadian rhythms. It's early evening, now. _Way to go, Watson, just confuse him a bit more_.

He speaks, but the words are too quiet to travel through the mask. You remove it. If his oxygen saturation stays steady, he can make do without for a while.

"Where are we?" Sherlock asks, words slow and slurred, but the acknowledgement of the two of you is good, so is using his words instead of just trying to fight off the Kraken of wires and tubes. He grimaces, presses the back of his head against the pillow as though seeking a more comfortable position.

You lower the side rail. "Hammersmith Hospital, intensive care ward. You had surgery, remember?"

His hand creeps up to his chest, tugs at the blanket. "Itches," he complains. His movements are lethargic, uncoordinated; one of the sedatives is still infusing, but the dose was an hour earlier. He fumbles around with his fingers a bit just under the edge of the blanket and you hope he's not trying to pull off the dressing on his wound.

"Someth… about… heart," he tries to answer your earlier question, then swallows painstakingly. "Head…che," he adds, dropping his hand back onto the mattress to rest beside his blanket-covered hip.

"You've got a headache?"

"Surgr––" he tries, then coughs and the exertion makes him close his eyes again, followed by an obvious exacerbation of pain. "Hurts," he complains, breathing in small, uneconomic pants now.

You twist your torso and lean down to retrieve a plastic bag on the floor. It contains a heart-shaped, air-filled pillow he'll need to hug against his chest when coughing to support the healing bones. He's just not been in good enough a shape to learn this yet. You slip the red pillow out of its bag, lift Sherlock's blanket and sheet and press it against his chest. He tries to shove it away, wincing.

"Hold it when you cough; it'll hurt less," you explain.

His fingers coil around the edge of the pillow, and he suddenly shudders, removing his hand as though it was scalded. "Out!" he commands, "no, _off_ ––"

Clearly, your gift is not well-received. "What's wrong with it?"

His eyes flutter as he strains to focus on you. He looks indignant, approaching horrified. "Plush on–– on–– plastic. Disgstn."

You push aside the curtain surrounding his bed and seek out the attention of the afternoon shift nurse whose name evades you. She raises her brows when she notices you. "He needs something for pain. Oxy must have worn off."

The nurse brings something up on the computer she is working at. "It would've been time for paracetamol in half an hour, anyway."

"Have you got a spare pillowcase? Need to slip this into something," you tell her, lifting the offensive cough pillow so she can see.

"Put it away," Sherlock protests. "Not having… it."

The nurse comes to turn off the sedative and promises to come back with some more pain meds.

Sherlock's gaze has regained a bit of focus, but it'll take some time for the aftereffects of the sedation to wear off. "Every–– bit's sore," he complains, warily surveying his surroundings. "Head's… it… headche."

"You've been in bed for a day and a half, including being on the operating table where you couldn't shift around. Not surprised you'd get sore."

"Slow… what… did they–– _stupid_ ," he curses.

You chuckled. "You don't need to be clever right now. Save your energy for growing your new valve back in."

"What valve?" Indignation seems to help in banishing the lingering effects of the dexmedetomidine. Trust Sherlock to be so irate over not knowing something that he'd punch his proverbial way through the haze.

"Your mitral valve gave up the ghost," you tell him, astonished at how easy it feels suddenly to talk about it. The epiphany makes you realise what you have both been deprived of in this ordeal: celebrating that Marston has been caught. How you would be feeling right now if it wasn't for that damned mitral valve is triumphant, basking in the afterglow of Sherlock's brilliance.

Still, there is cause for celebration. He's not out of the woods yet — complications could still arise, but he's awake, the surgery's done. Suddenly, you're all giddy about that. You have your best friend, your partner, your _person_ back, the one who you can't wait to see and talk to every morning.

"Easier to breathe," Sherlock analyses after scrunching his forehead up in that comical way you've only seen when he's drunk.

"That's good and expected. Your blood's not back-washing into your lungs anymore."

He coughs, then curses, eyes squeezed tight. "Fucking––" he starts, then another coughing fit grips him. He never curses unless he's in severe pain.

You've only heard such language from him once when he dislocated his elbow falling off a–– never mind. Not relevant right now. "Want to try that pillow again?"

"Don't want anything on my chest right now."

You'll try to convince him later once he's coherent enough to understand the benefits of a counterpressure on his thorax when coughing raises the pressure inside it.

The nurse comes back with a small bottle of intravenous paracetamol and a syringe of what is likely oxycodone.

In only a few minutes after the oxy dose, Sherlock sighs contentedly.

"I like that," he says, "whtrverrr it is."

"It's just for the first few days." Maybe a week. Maybe two. You don't know how long the pain will remain this severe. "Don't get used to it," you warn.

 _Don't get used to it again_ , you add in your head.

_____________

Later in the evening, Sherlock's roommate and the man's nurses disappear. The bay next to Sherlock's remains empty for an hour before an army-issue cot materialises in it. And so does Mycroft Holmes.

Not much about the two brothers and the things they can do surprises you anymore.

"I have been told all hospital beds are reserved for patients," Mycroft explains, his distaste obvious, "so, in lieu of a proper bed, it was decided that a temporary solution should involve something on which you are accustomed to sleep."

His thinking does contain some logic, but even every lilo you've slept on has offered a better rest than an army cot. Still, there could be no cot at all, so you nod. Saying thank you seems… beside the point.

You spot an RAMC toiletry kit on the bed. Unused, you hope, then almost chuckle as you try to imagine Mycroft Holmes sneaking into a dormitory at Sandhurst to steal a toothbrush. God, you're tired. Everything feels unreal and ridiculous.

Everything except the sight of Sherlock on the bed, that is. He insists on not even touching the damned cough pillow with a pillowcase on top. Says the texture of it is like nails on a blackboard. He's tried a regular pillow, then declared that having anything pressing on the wound and the drains is too disgusting.

"Is he allowed non-steroidal anti-inflammatories?" Mycroft asks when nurse Emma returns with a large syringe in hand — Sherlock's low-dose noradrenalin infusion is running out soon. He can't quite sustain a sufficient blood pressure yet without a bit of pharmacological support. Perhaps his left ventricle is slacking off now that it doesn't have to rush to pump into the aorta what the atrium has delivered so that at least some of it would get past the aortic valve.

Mycroft is clever and never fails to impress you with the research he's done into any issue which arises with Sherlock. He seems well-versed in medical things, which makes you sad — it might be a testament to how many medical issues of Sherlock's he's had to help sort out through the years because his brother's self-care is at worst abysmal and, at best, lacklustre. You wonder how much of a relief it is for Mycroft that, as Sherlock's live-in-doctor, you have taken over some of those duties without realising.

"Paracetamol's on the list regularly as well as a slow-release oxycodone, and once your coagulation panel is normal, we can put you on ibuprofen or naproxen since you don't seem to have any contraindications," Emma explains, directing her words to Sherlock. The nurses in the unit seem well-trained in not ignoring their patients when discussing their cases, even though many of them are sedated and on the vent. As alien and dehumanising an environment as an intensive ward should be, you find the staff's good attitude a potent antidote to it.

"Anything else than opioids is like pissing in the wind," Sherlock complains, grimacing as he tries to readjust his position on the bed. He told Emma earlier that his back muscles are cramping from lying down for so long. The head of the bed was raised so that he was nearly sitting up, but his BP dropped too much to stay in that position.

Emma swaps the old syringe for a new one, then checks the dressing covering the entry point of his large central line.

"That thing sticks," Sherlock complains. "Can't you take it out?"

"We usually do that when a patient is well enough to go back to the cardiac care unit or insert a softer inner cannula. It's a good line, big enough for anything you might need," Emma tells him. She doesn't seem at all bothered by his crankiness. She must see this all the time: patients reacting in wildly varying ways to being severely ill and injured, to being in pain and anxious.

Exuding irate superiority is how Sherlock compensates for moments when he's reminded of his mortality. The best way to stay on his graces then is to show respect for that, to not call him out on it.

"They gave you a bilateral serratus block for the pain at the end of the operation, but it stops working after about twelve hours." Emma says. "What that means in layman's terms is––"

Sherlock's venomous glare could melt metal. "I am not a _layman_."

"Technically––" Mycroft starts, then clears his throat when Sherlock gives him the stink eye as well. "Thank you, Miss Carlton," Mycroft says, in an obvious attempt to discourage Emma from attempting further conversation.

Sherlock seems to have decided to dislike her on principle, and there is little she could do to change that. To him, she probably symbolises everything that's going on: being ill, being in the hospital, being told he can't do certain things.

"Thirsty?" you suggest. "We could get you some ice chips, maybe a bit of water."

"I'm not a child who's just had a tooth out. I want _tea_."

It's a good thing you don't give in to that because, after just half a cup of cold water, he throws up which exacerbates the pain. All his reserves are spent on recovering from surgery, so GI tract function is not a priority.

The following hours are a test to the patience of all concerned: nothing seems to help as his pain level increases and his frustration builds. There's oxycodone, more paracetamol, even ketamine with midazolam.

"Just _shoot me_ ," Sherlock squeezes out from behind clenched teeth at you after the evening entourage of rounding doctors and nurses leaves. "I'm sure that would hurt less." He had remained silent during their visit by his bedside, presumably because he hadn't wanted to miss any pertinent information. He'd managed to also suppress the need to express his pain for those fifteen minutes, but now he's panting because of it.

There's more ketamine, and a disconcerting two hours during which Sherlock goes on a hunt for invisible insects he keeps finding in the bed. While ketamine is a good battlefield anaesthesia drug and a practical addition to any regime for controlling challenging pain problems, it's also a hallucinogen even when combined with a sedative. At least the pain seems to have decreased in intensity.

Eventually, a decision is made to re-establish the nerve block using catheters installed near the pertinent nerves which will administer a continuous infusion of local anaesthetic. Sherlock listens to the anaesthetist's explanation of the procedure with an unflappable conviction that he wants it.

"Install a catheter or jam an ice pick in, I don't care," he informs the registrar. "Why didn't you idiots install those catheters in the first place?"

"Most patients don't need a continuous block," the young man explains. "Though I'll admit your history could have been taken into consideration a bit more. Favouring nerve blocks is a recommended approach for pain management with–– um."

"Former or active addicts," Mycroft provides helpfully. "It's quite alright to be frank with him, Doctor Marsh. Lord knows he never spares anyone's blushes."

"Hypersensitivity brought on by opioid use has been shown to fix itself after a few months of abstinence," the anaesthetist replies.

"While the opioid _tolerance_ remains," Sherlock counters.

"That has been taken into account," you point out, wanting to establish that not everyone in this hospital is the idiot Sherlock assumes. The bolus doses he is being given of oxycodone and morphine would knock a smaller woman without a history of opioid use out cold.

The nerve block catheter installation goes without a hitch once the ordeal of getting Sherlock to lie fully on one side, then another without dislodging anything is over and done with. The block kicks in fast, and even Sherlock's blood gases improve as the pain is no longer making him afraid of taking deep, proper breaths.

He takes a three-hour nap, which allows you and Mycroft to regroup and refresh yourself. He goes home, promising to return for a lunchtime visit. Late at night, one of his minions shows up with a delivery from Mrs Hudson: several small containers of treats and snacks chosen with the skill of someone who has catered to the fickle tastes of Sherlock Holmes for years.

You text her to thank her, hoping she'll still be awake.

' _Just keep that foul brother's hands off these_ ', she warns in her reply. ' _He would never hesitate to snatch the last piece of cake from the tray_ ', she adds a moment later, then explains: _'had to use some gentle blackmail to get the delivery done_ '.

Were you any less tired, you would certainly investigate what on earth Mrs Hudson could have on Mycroft Holmes.

There is also a small thermos in the delivery: _orange pekoe tea_ , according to a handwritten label. It makes you smile because it's Sherlock's favourite. Once he wakes up the next time, maybe he could try if he could keep down some of it. The man calls any tea not brewed from proper leaf _Twinings-labelled floor scrapings_.

**Notes for the Chapter:**

> arterial line = small cannula in a distal artery; used for continuous monitoring or blood pressure and for easily drawing blood samples. If accidentally pulled out, the puncture site can bleed a lot because the pressure in even a small artery is much higher than in a vein.
> 
> benzodiazepines = a class of tranquilising drugs
> 
> bolus = a single injection as opposed to an infusion which is a continuous way of administering a medication
> 
> dex = dexmedetomidine = a modern intensive care sedative administered as an infusion
> 
> opioid tolerance = anyone who takes (strong) opioids as a medication or an illicit drug, will experience this physical adaptation where larger doses are needed for the same effect as opioid receptors get used to floating around in a certain base level of the substance
> 
> delirium = hospital delirium is particularly common in critically ill patients who’ve had major surgery. It’s a temporary state of cognitive deficiency, often missed if it’s lethargic rather than agitated, and can affect a patient’s outcome adversely. Many cases are preventable by avoiding drugs which predispose to it, by helping patients keep track of the time of the day, by providing a familiar presence and palatable amounts of understandable information on what’s going on. Minimising hearing and vision impairments and sleep deprivation is important as well as effective pain management. Treatment is mainly supportive; drugs can make things worse unless they’re needed to enable safe treatment. Antipsychotics can be better than tranquilisers. As I mentioned, combative and agitated delirious patients are easier to diagnose than withdrawn, lethargic ones, but both can be suffering from significant delirium. Sometimes there really are wrestling matches, particularly if a patient pulls out all their lines and endangers care.
> 
> central line = a cannula inserted into a large vein, the part inside the vein extending all the way to the superior vena cava. The one Sherlock’s got is a large-bore one, and rather stiff; he’d definitely feel it when turning his head. Such a large one is needed to fit in the pulmonary artery catheter (aka Swan-Ganz catheter).
> 
> visiting hours at an ITU/ICU = visiting at these wards is often limited to the immediate family. Mycroft can, of course, get all the necessary rules bent for John. If a patient is close to death, official visiting hours (if there even are any) are made flexible. Family members don’t often stay very long with patients who are sedated and on a respirator.
> 
> NSAIDS = non-steroidal anti-inflammatories = drugs such as ibuprofein and naproxen which lower fever, help with pain and inflammation through manipulating the cyclo-oxygenase enzyme. They have lots of contraindications and potential side effects, and together with many other drugs can increase the risk of bleeding. We can’t often use them on patients with cardiac surgery/heart disease, but since Sherlock is otherwise healthy and pain management for him is a challenge, they might be considered. They affect platelet function adversely.
> 
> ketamine = a peculiar anaesthetic which creates a dissociative-type general anaesthesia, including analgesia (pain control). Can cause intense hallucinations but does not compromise breathing. Is mostly used nowadays in small doses as an additional pain drug rather than a general anaesthesia hypnotic. In battlefield medicine it’s still an important substance.
> 
> Serratus anterior nerve block = can be used to manage pain in patients who have undergone heart or lung surgery. It can be a single-injection block with a limited duration or a continuous one using catheters.


	7. Look Beyond

While you and Mycroft find many promising things to celebrate in the next twenty-four hours, Sherlock appreciates none of them. He refuses to see things in the context of the life-threatening cardiac failure he arrived in or what he has been through in the OR. Instead, he judges his physical limitations against the backdrop of a healthy Sherlock. When an intensivist tells him during the morning round that his thoracic x-ray no longer shows pulmonary oedema or pleural fluid, he just rolls his eyes. It's such a Sherlock thing that you can't help but laugh, but in your gut churns the worry that this is the start of the challenging part. He's getting well enough to be able to manage denial, only to bang his head against the wall when his body reminds him of the truth. You wonder if you're going to be reminding him like a broken record until you're hoarse that he's had bloody _open heart surgery_ and that's why he can't leave the hospital to go digging around skips for the remains of bodies or vault over garden fences just yet. He will, eventually, because there's no reason why he can't make a full recovery, barring complications. It's just that he's the world's least patient man.

If he only attempted to cooperate with the care he's being given! You know it's just an emotional coping mechanism — a crappy one — that he fights everyone and everything; tries to refuse and decline things on principle, but it grates on your nerves to see the nurses and your fellow physicians being subjected to his cantankerous obduracy. Routine inquiries on whether he'd have use for the bedpan and the existence of such medical paraphernalia as the Foley catheter are regarded as profound insults on his dignity and intelligence. He delivers scathing, extensive rants on subjects such as the torture of the artificial fibres in the hospital-issue clothes, and he won't touch the hospital food no matter how many times you tell him he can't build up his strength on tea and Mrs Hudson's treats alone.

Mike comes to see him just after the morning round, and reminds him of the news that, since an artificial valve was needed, Sherlock will be on anticoagulants for the rest of his life. You're not sure that he remembers such a detail from the barrage of data on the day he was brought in, and once Mike finishes his explanation, the temperature in the room goes down several degrees. There is a string of _why_ s and it seems that Mike's considerable verbal prowess is coming up short in explaining to Sherlock why he can't just try his luck without such medications. It would be a no-brainer to anyone but the world's most stubborn man who still seems to believe that they're immortal even after nearly succumbing to cardiac failure.

At one point in the heated conversation Mycroft, who'd arrived at the same time as Mike, gives you a stern but sympathetic glance — perhaps he can see you're about to snap and say something rather harsh.

"We're all here for this adjustment process," the older Holmes tells his brother. Even though you know he's doing his best, to Sherlock it probably just sounds snidely smarmy.

"I'd like you to adjust yourselves out of this room," Sherlock tells him. "All of you."

You are left wondering if that really means you as well. You twitch towards the door.

"John, stay."

Apparently, you're exempt; you'd begun to fear that for Sherlock, you might start representing the medical establishment in this conversation, too, and become the enemy.

Sherlock doesn't seem to want anything but your silent presence, though; there is no conversation since he either naps or frowns at the ceiling for the next four hours. Mycroft makes himself scarce after just one; it seems that there is a limit for the amount of oppressive silence he's willing to endure.

You offer Sherlock his phone or the TV, but both are declined. He seems antsy, yet reluctant to shift around on the bed. His posture is stiff; he's acting like someone on whom a spider is walking, and they're too unsettled to flick it away themselves.

"Emma says you could have a sit at the edge of the bed once those drains come off," you offer.

"Oh, joy."

Frustration is emanating from him in waves. His hair is a fluffy mess, at which he tugs and then growls in frustration. You remind yourself that these ripples on the surface of his moods are likely not the entire truth. He's not had any time to adjust to what's going on. The big waves rolling underneath might only just be approaching the coast.

"Anything I can do, just say the word," you say quietly.

"You won't do it," he wants me.

"Try me."

"I want these off. All of them, _off_. They scrape and irritate and itch and these," he indicates the chest drains, "they're––"

"Disturbing?" you suggest.

He looks away. "If they shift, I feel it somewhere inside. Where do they even go, precisely?"

"Do you really want to know?" You're not too sure, either, what with not being a cardiac surgeon, but you're pretty certain at least one of them sits very close to the heart.

You use the call button; Emma is never far away. "When can these go?" you ask her, indicating the drains. There has been very little exudate or blood coming out in the last 24 hours.

"I was just about to call his intensivist; he was supposed to take them off after the round but had to go receive a new patient." Emma bites her lip. "I wonder if he'd mind if you did it?"

"I don't work here." Though you've never inserted such drains, you have removed plenty of them.

"Do it," Sherlock commands, "or I will."

Emma makes a phone call and returns with a pair of sterile gloves. "This isn't what we usually allow, but there was a note in Sherlock's file saying that it's fine to involve you." She seems a bit puzzled by this.

You're tempted to ask if the note was hand written on MI6 stationary.

Emma removes the dressings. After you've donned a mask and a pair of sterile gloves, you cut the thick sutures fastening the drains to Sherlock's chest. The drains come out easily, followed by snake-like slivers of clotted blood.

Uncharacteristic for a man who never misses a chance to partake in some human gore, Sherlock looks away as you remove them with wads of gauze, close the small skin incisions with a couple of sutures after numbing the edges with lidocaine, and replace the dressing on his chest. Sherlock has been quiet throughout, and when you take off your mask and gloves you notice he's gone a bit green around the gills. The ensuing retching produces little into an emesis basin but visibly exacerbates his pain. The nausea doesn't last long but leaves him embarrassed and tetchy. You decide it's best to give him a moment alone and allow Emma to coax you out to the family room for some tea and a biscuit.

She asks if the two of you have been together long. You don't really worry that your visiting rights to the ITU would be rescinded if you turned out to not be a romantic partner, but you still don't correct her. In fact, the assumption is convenient because it means you feel that you don't have to explain any of your behaviour around him. Not even Mycroft has ever batted an eyelid at any of it — after all, he was the one who insinuated your and Sherlock's nuptials were imminent upon your first meeting. That's why you assumed Sherlock was gay; why would his brother have joked so casually about such a thing if it wasn't true?

Sherlock doesn't care what people think about the two of you. You haven't quite managed that level of confident nonchalance yet, but right now, you're finding it easy to push those worries away. He needs you and seems to want your support rather than anyone else's. If only you didn't feel like you were walking constantly on eggshells trying to decide when to give him space and when to breach the bubble of aloofness he tries to construct around him to protect himself from the bleak reality of intensive care.

Barely ten minutes later, another nurse comes to fetch Emma. "Oh, there you both are. He's asking for Doctor Watson."

"Who is?"

Nurse Jo, who has also looked after Sherlock for a shift, grins. "Take a good guess."

  
_____________

The nicotine patches introduced before Sherlock's first sedation break don't seem to be doing the trick any longer. There are now three of them, and it had taken a lot of convincing and a detailed explanation in the hallway outside Sherlock's room conveyed by Mycroft to the ITU registrar regarding how Sherlock likely has fewer nicotine receptors than most and thus requires larger doses of nicotine to achieve the calming effect people seek from smoking. The hospital has no other formulations available than the patches, so a week's supply of extra strength nicotine supplement mouth spray is delivered by one of Mycroft's agents.

You've stood beside the two of them as they conversed. "You really want to feed that addiction right now?" you ask the older Holmes after the registrar excuses himself.

"A physician should know that acute illness is the worst occasion for detoxing someone off a narcotic habit. Keeping him calm should be a priority for his heart. The side effects of indulging him we'll deal with later."

He's looking at you pointedly — as a family member who's been through the thick and thin of Sherlock's addictions — and is dismissing you for being the newcomer. You relent.

"There are theories that a brain like his may gain particular effects from substances activating nicotine receptors. They may provide additional focus, enhance the ability to calm oneself."

"Aren't there other options besides nicotine?"

"There are, yes, one of them a drug used to treat nicotine addiction, but I doubt the physicians here would approve of it in his state. Plus, as you are likely aware, it would render the opioids he's on for pain management useless. I've already asked the intensivist to exchange whatever they were using before as an anti-nausea agent for tropisetrone."

"What's that?" It's not a drug you heard of when you were in medical school.

"It affects the 5-HT serotonin receptors and the nicotinic receptors."

"You and Sherlock should have been pharmacists," you scoff. One brother uses their extensive knowledge base for getting high and solving crimes, the second one tries to outwit the other's receptors into not shooting the proverbial wall when they can't do either.

"I have always kept on top of current research. He is my only brother," Mycroft comments indignantly. "And may I remind you that he _is_ a graduate chemist?"

There's a question on the tip of your tongue, and it's about Mycroft's need to keep up with all those new studies in the first place. You have never wanted to ask Sherlock this question because you've feared you would insult him. You have always had a hunch that Mycroft would gladly answer it for you, but you also don't want to go behind Sherlock's back to snoop around his medical history. Maybe he's not even diagnosed? Not all people are who are very… high functioning.

You have your opening, now, for that question — the context of this conversation. You clear your throat and hope to sound more like a physician than a flatmate snooping around. "He's… he's got Asperger's, doesn't he? Or something like that. The deduction thing, I mean, and the… everything, really."

You would never want to box Sherlock in, to treat him like some stereotype — people do that very often, so Sherlock offers from a more frightening box, instead. That preposterous excuse of being a sociopath… how do people not see through that the minute they get to know him better? How do they not see that those walls he builds might be thick and high, but they're outstandingly brittle? If he really was some sociopath without empathy or remorse, he'd have no need for those walls because none of people's proverbial sticks and stones wouldn't hurt him. You would never want to think of Sherlock as just a representative of a diagnosis because he's so much more, but you do need to know, don't you? You should know, being so involved with him in ways you'll need to pick apart one day in more detail. Not right now, though. Not in the midst of this bloody crisis.

" _Everything_ is a good summary of how it affects his life," Mycroft answers courteously, "the precise diagnosis he received is a product of a less informed age, so it is best to say that yes, he is on the autism Spectrum. The last thing he would want, however, is to discuss it."

"Yeah, I… gathered. He tells people he is a sociopath."

Mycroft briefly closes his eyes, a weariness setting into his posture. "Better to be feared than pitied. Curious that he should choose a disguise which is, in many ways, the very opposite of what he is like. I am glad to have observed that you've never made the mistake of assuming he lacks emotion or caring. And you certainly do not lack those things towards him."

His phone rings, then. Saved by the bell; you are growing uneasy under his uncomfortably observant eye. He treats you like family, offers you access privileges not even granted for the rest of their family. He assumes you are here for Sherlock and never bats an eyelid no matter how intimate your interactions with his little brother are. This isn't what flatmates do and telling yourself that only makes a stubborn sort of determination rise in you. It makes you want to continue on this path, to be here, because where else would you be than by Sherlock's side?

"He trusts you — enough to assume you will see past his behaviour. He has no skills in expressing his emotions. Mostly kept locked away, they spill out at inopportune times when he is under tremendous stress. Look beyond what you see," are Mycroft's parting words as he heads for the lifts and you prepare to re-enter Sherlock's room.

You assume that a heavy dose of nicotine will make him antsy, distracted, more restless than before. The few fags you've smoked in your twenties at parties always made you queasy and restless in an almost agitated way. You never experienced the buzz others boasted from it, nor can you imagine how it would help you focus or perform.

Sherlock, however, after five doses of the short-acting spray, falls asleep and stays that way for the rest of the evening.

  
  
  


**Notes for the Chapter:**

> Don’t take the scientific-sounding nicotine stuff here as presented by Mycroft as gospel. There’s a lot of controversy around the autistic brain, and a lot we don’t know. Mostly all this stuff about nicotinic receptors served as a plot device to land the conversation where I wanted it. Don’t smoke — it’s the stupidest decision you could make for your health, perhaps save for jumping in front of an incoming train.
> 
> pleural fluid = systemic illness, lung disease, sepsis, cardiac issues and chest trauma and cardiothoracic surgery can all lead to an accumulation of fluid in the pleural sac, which surrounds lungs. There needs to be a bit of pleural fluid for healthy lung function.
> 
> Foley catheter = urinary catheter
> 
> removal of drains = doesn’t often require stitches, unless the drains are particularly thick and/or the removal holes weep a bit of blood.
> 
> tropisetrone = a drug used to prevent nausea and vomiting and to treat them during and after anaesthesia. Originally the setrones were developed to combat nausea during chemotherapy for cancer.
> 
> Asperger’s syndrome is no longer a separate diagnostic entity in the neuropsychiatric diagnostic classifications. Sociopathy is a feature associsted most often with antisocial personality disorder, not a separate personality disorder.
> 
> Yes, people do actually get cranky and act childish and complain and take their anger over getting sick or injured out on healthcare staff. It’s a part of professionalism to recognise that, see past it and not let it affect you (too much). Sometimes patients need an emotional punching bag for a moment and it’s okay; they often realise afterwards that’s what they were doing. There is, however, no excuse for really shitty behaviour or violence towards healthcare staff. It’s not my fault someone broke their leg — my job is to facilitate a surgeon fixing it in a safe and painless way.
> 
> anticoagulation after valve surgery = an artificial valve causes extra turbulence in blood flow inside the heart which can lead to blood clots. Those blood clots can then travel to the brain and cause stroke or even death. This is why someone with an artificial valve needs anticoagulation: to prevent clot formation and to dissolve building clots. Those anticoagulants carry their own risks, of course — including risks of bleeding from the GI tract or a brain bleed, but that risk is still smaller than a significant clot-related complication.


	8. The Wrong Words

The move back to the Cardiac Care Unit is a relief. Though his ECG, oxygen saturation and blood pressure will still be monitored continuously, the HDU unit should feel more like a regular ward than the ICU did. Sherlock gets a proper single room, there is a much more normal daily routine and less ambient noise. Though released from the drains and the wires for a temporary pacemaker which was kept on standby, there are still various lines and monitoring wires which prevent Sherlock from moving about freely and leaving the room. Not that he would — even just sitting on the edge of the bed or in a chair by it drains his reserves. He doesn't ask for help so that he could do those things, and you assume it's both because he hates needing the help and because such evidence of his current infirmity decimates his already dejected mood.

You don't have to glance at the monitor to know when he's having extrasystolic beats or some other brief arrhythmia. He just… stops; freezes, even, until it passes, focus firmly inward. If you say something to him then, he'll ignore or won't even hear you. Afterwards, he's subdued, thoughtful, and even less willing to anything that would exert him.

It's not his usual sort of thoughtfulness — that intense, bloodhound-like concentration when his gears are turning to solve a problem. No, this is absent-minded, scattered, lethargic and might get interrupted with his lids drooping and a snore erupting. The only thing that seems to raise his heckles are the rounds. He grills the doctors about minuscule details, about risks and statistics; he challenges their expertise — and consequently the limits of their bedside manner. You're reminded of a caged wild animal circulating their pen trying to find that one weak spot, that one mistake, that one truth that would unravel it all. He demands data about rare complications, about the meanings of things on the radiology statements and lab results. Your theory is that what looks like distrust towards those caring for him is actually worry about whether an issue could develop with the artificial valve which would force him to go through all of this again.

Your apologetic smiles feel so toothless and disloyal towards your fellow physicians. You should speak up, take charge, get Sherlock to just stop. _Just stop and be a decent patient_ , is what you're tempted to say. _Would that be so bloody hard?_

Yes, it would be for him, and the last thing he needs is for you to dig such a battle trench between the two of you.

You hope, at least, that the move out of the ICU might have some symbolic value as inching him closer to a day when he gets to go home.

This morning, the head of cardiothoracic surgery cuts his interrogation short and moves on to the next room.

"Once it's grown in, it should stay there. They didn't give you a biological replacement valve because those don't last as long. A mechanical one's better for younger patients," you explain, parroting the words of the surgeon from five minutes ago.

" _Better_ , even though they mean I'm having to ingest _rat poison_ for the rest of my life. What I want is an explanation as to why that choice of valve type wasn't presented to me," he replies venomously. "They just keep sidestepping that."

"Because this isn't a Tesco where you pick the valve you want off the shelf. They don't do biological valves on patients as young as you, period. There was no choice, really."

"No choice except to turn me into the equivalent of an old man," he snaps and crosses his arms. This dislodges an ECG electrode, the glue of which then gets attached to his sparse chest hairs and must be peeled off as a new electrode is installed. You'd laugh at his put-upon expression if you weren't so damned tired.

It's been days, now. Feels like much longer. You're deprived of sleep, exhausted from being constantly on high alert both for Sherlock's physical health and his mental state. Mycroft does what he can, but Sherlock holds him at a proverbial arm's length. You're the real support and punching bag, and you are getting a crash course in seeing behind what he says and what he doesn't know how to express.

________________

  
Mycroft's words about seeing beyond Sherlock's behaviour won't leave you. On a surface level, Sherlock is acting quite like himself — tetchy, impatient, headstrong, insists on doing things his own way. Yet, there is a strange hiding-in-plain-sight evasiveness whenever someone tries to discuss the long-term consequences of his valve replacement. He either sulks or insistently gets stuck on arguing some peripheral detail.

One of these conversations leads to the on-call intensivist marching out in a huff after Sherlock has insulted not just his intelligence but also his fashion sense, his upbringing and his accent.

All this commotion… over when Sherlock will be allowed to shower. You get it: being deprived of his routines, including personal hygiene, grates on his nerves. Sherlock is a creature of habit only in that sector of his life; perhaps he needs it to keep the contents of his head in order. The rest of the flat is in disarray largely due to him, but his hair products and other toiletries are meticulously arranged and curated, as are his clothes, apart from the disguise stuff.

It's an armour as well, a projection of perfection which should repel easy insults. People can still insult other stuff, though.

The day you met Sebastian Wilkes for the first time, you couldn't get any sleep at night — not until you realised what had been bothering you all day. It was that throwaway correction you'd made, a comment you barely even remembered about being colleagues. When you finally put two and two together, you nearly went downstairs to knock on Sherlock's door. This was a man Sherlock had clearly loathed all those years ago, someone who was a social ringleader where Sherlock was the outcast. It's not quite true that Sherlock doesn't care what people think, is it? You'd thought so, which is why you'd assumed Wilkes' opinion didn't matter.

The epiphany you had that night was that Wilkes' opinion was inconsequential on its own, _yours_ mattered. And Sherlock feared Wilkes had stripped off that armour, revealed how people tended to feel about Sherlock. It suddenly fit with the scathing whiplash insults flung at Donovan on the day you'd gone to your first crime scene together. Donovan's words threatened Sherlock's attempt to convince you he wasn't what so many had thought of him. That he could be someone you liked. Someone you wanted to be around.

You never apologised for that fleeting moment when you saw how much Sherlock could be hurt and how that pain of rejection and isolation could bleed through his facade. Once that moment passed, he then descended upon the case like a black angel of revenge, relishing taking his former schoolmate down a peg. Now, there is something unsettlingly similar in the way he's lashing out at the entire world.

He's doing it to keep the world from getting the first punch in, you realise. He's doing it to repel the reality of what's happened to him.

He's not asleep right now. The TV is off, just a dim nightlight on in the corner. You've put away your book, and the ward is quiet as the hour approaches midnight. He should be resting, but instead he's tossing and turning and the intense restlessness emanating from him you practically can feel on your skin as it charges the air in the room.

You feel like you're both holding your breath, waiting for the other to make a move. To say something. To break the logjam.

"Sherlock?" you ask.

You hear his breath hitch. He's waiting. You know, somehow, that he won't answer you. Not yet. Perhaps not at all.

"It's a lot to take in." You're a broken record full of platitudes and want to kick yourself. "It's okay not to be able to… accept things yet. To feel like it's a bit much."

After you got shot, it was a constant whiplash between hope and disappointment. Crushing defeat and occasional flickers of determination. Anger. Fear. Doubt. Was the tremor in your hand just PTSD — bad for a surgical career — or permanent nerve damage — ever worse for a surgical career — or both? (Just quit now before it all sinks in properly, eh?)

You were shit at adjusting to anything. Does that make you better or worse equipped to help Sherlock?

"Don't," he warns you quietly, his voice a low growl.

"It's fine not to know how to talk about of this."

" _John_ ," he warns, and this is your final warning before a verbal trigger is pulled.

You're not afraid of him. There's nothing he could say that would break your determination to be there for him. "I'm here. Whatever you need, I'm here. You don't have to say anything."

He doesn't.

He's not ready.

________________

Perhaps the worst constant strain on his nerves now that he is awake more is that he can _hear_ the new valve. You can hear it, too, if you lean close to him. It's a steady ticking which you find reassuring, but for Sherlock, it appears to be the equivalent of Chinese water torture. He doesn't adapt to sensory things like you do. Not to clothes which don't fit like a condom, not to ambient smells or sounds. Not to a constant ticking from his chest.

"I sound like a bomb about to go off," he complains.

That's how you feel, too, under the barrage of needing to adapt to his whiplash moods. During the brief periods when his anxiety lets up, he gets painfully bored but is too restless to focus on TV or reading.

Instead of dinner, he's indulging in a rant bordering on a tantrum about the fact that _nobody told him_ he'd have to _listen to some incessant ticking for the_ _rest of his bloody life_.

You're just about ready to march out for some air, when Mycroft walks in, a picnic basket out of all conceivable possibilities on his arm and what looks like a laptop sleeve under the other. Soon, Sherlock has been gifted with a pair of high-end noise-cancelling earphones and a laptop full of classical music. You try to imagine Mycroft Holmes pulling some hapless minion off the duty of watching over the Taliban to fill his brother's MacBook to the brim with the multiphobic Greek sonnets of Whatsits, or whatever it was that music thing you once heard the two brothers discussing animatedly.

The rest of the contents of the picnic basket turn out to be a selection of looseleaf from Whittards, three cup sets of fancy tea china, an electric kettle with no less than nine settings for different teas, a teapot and a matching cosy. There's also shortbread and flapjacks, undoubtedly from some fancy bakery. Both are things Sherlock likes when fresh and well-made. It doesn't change where you are and what's going on, but when has a nice cuppa and good food ever failed to lift everyone's spirits?

"No reason to drink dishwater though one is in clinic," Mycroft explains primly and arranges everything onto a side table, "and Mrs Hudson can hardly be expected to wait on him hand and foot in here."

You've never seen the older Holmes make tea; his housekeeper probably does it at home, but surely, she's not available around the clock?

Mycroft nods towards the bed, where Sherlock is now looking restful for the first time today, eyes closed but fingertips occasionally tapping against the mattress as though he's thinking of violin patterns. "He won't admit so to me, but while he greatly enjoys the Renaissance and Baroque eras, when it comes to the violin, he'll most likely choose a Late Romantic piece. Appeals to his sense of melodrama. You can even tell that preference from watching him play; he is highly skilled, nearly up to the level of a professional orchestra musician in the techniques required by Baroque pieces, but his Romantic playing is, while technically equally admirable, more… spirited. Exceptional, really, for a hobbyist. Somehow, he manages to keep the works of composers such as Brahms from succumbing into schmaltz while still employing the typical, almost cliché lush vibrato, exaggerated slides. He does have a rather obnoxious signature rubato habits; he never does things by halves, especially not romance."

You wouldn't know. Your classical music education consisted of two years of clarinet lessons. You never really even learned to read sheet music very well, and sometimes you feel like you are even worse at reading Sherlock. "If he's that good, could he have become a professional violinist?"

Mycroft frowns and plugs in the kettle. "He clearly had the requisite talent, but little of the discipline required of such a profession. He'd constantly argue with his teachers, wanting to tackle compositions well beyond his skill level. When they told him no he would simply grind at it until he could master the techniques. And, there were… other issues during the very important formative years which determine whether one gets to move forward in a musical education."

"Was he a terrible teenager?" you ask, grinning as you try to imagine Sherlock as an awkward, lanky teenager going through a growth spurt.

Mycroft's lip quirks up in a secretive, fond smile. "He got expelled a few times."

"Which school did you go to?"

"I attended St Paul's as a boarder. Sherlock began at Abingdon House, then later transferred to Westminster. Abingdon was close to our home in Kensington and was a good fit for him with his particular… _challenges_ ," Mycroft says pointedly. "Our parents very much doubted that he would have adapted to boarding."

You almost ask what he means, but then it hits you how inappropriate it feels to discuss this in front of Sherlock, regardless of whether he's listening or not. You've known he's not like most people, that he thinks differently in many ways, that he's brilliant and impulsive and so deeply oblivious to some things which surprise you because you're used to people understanding and picking up on those things instinctively. Now, you know why, but hearing the diagnosis had changed very little, if anything. It's just an agreement on what to call a cluster of symptoms, and some of those Sherlock might not even consider as such — as signs of pathological functioning. For you, as well, they're just… _Sherlock_ things.

Glancing at Mycroft, it occurs to you — and not for the first time how different your childhood was from the Holmes'. You went to the village school, then the nearest sixth form. You have no idea why someone would live in London and send their kids to a boarding school in the same city. All those ideas of constant peer socialisation and such seem rather elitist and old-fashioned to you, and your parents could never have afforded to pay tens of thousands of pounds for your schooling per year. They struggled to make ends meet. You were a hard-working student, and you knew what you wanted, and that's what got you into a university. Not Oxbridge, not even anywhere in London, but a decent medical programme. You're aware Mycroft is an Oxford graduate, and that Sherlock attended Cambridge for an undergrad degree, then dropped out soon after, though he was admitted to a PhD program. You can't help but wonder if those two geniuses couldn't have got into such institutions even from less prestigious sixth form schools.

Sherlock is so out of your league in so many ways.

"I don't know what I'm doing," you mutter, watching his fingers tap on the blanket as he focuses on the music, eyes closed.

"What you are doing," Mycroft responds quietly, "is better than anyone else."

You wonder if that also includes him. Mycroft seems to have made himself less involved than he usually is when Sherlock ends up in the hospital or in trouble; you wonder if he is consciously making room for you, and whether you should read something into it. It's probably just because Sherlock has signalled that he wants you here. Or does he? The signs have been few and far between. Mycroft seems to think differently, though, but then again, he's had over thirty years to learn how to interpret the strange creature that is his brother.

The tea has brewed, and you deliver Sherlock his cup, placing it on the folding attachment of the bedside cabinet. He opens his eyes, pulling the headphones off. You can see the laptop screen now; it declares that what's been streamed into the headphones is _Missa Pro Defunctis_ by someone called Ockeghem.

"Rarely performed and even more seldom recorded," Sherlock comments appreciatively. The angry lines which you have feared would etch permanently into his features are gone, and his heart rate is down, too. "Earliest known polyphonic death mass."

"I believe Dufay's was written even earlier," Mycroft says with a hint of challenge.

"Legend says it was lost, but I am more inclined to believe it never even existed. Convenient excuse; _'oh, I wrote one too, but have terribly carelessly misplaced it_ '," Sherlock comments blithely.

"I'm glad the same fate has not befallen your sense of humour," Mycroft comments. He has the sense not to stay for too long; it seems to lead to arguments.

Sherlock spends the rest of the evening listening to pieces, making notes and searching for things which he then explains at you about as though you could understand all the complicated explanations of the technical aspects of early classical music. The way he lectures at you is always a strange mixture of assuming everyone knows — or at least should know — those things and despairing over your ignorance if you express it. It's best just to nod.

Eventually, he starts yawning. He succumbs to sleep before nine in the evening and sleeps for thirteen hours straight. It seems that the music has helped him disentangle from the fight-or-flight state he's been in ever since getting breathless while chasing a suspect.  
  


________________

You mean to go home the next evening, you really do, but the oddly luxurious armchair with a reclining back which appears mysteriously in Sherlock's room seduces you to fall asleep after the evening news. Sherlock has been dozing on and off, not complaining much, and has even had a bite of his dinner, which has lulled you into a false sense of security. The arterial line is gone now, but he still needs constant ECG monitoring.

You're not even sure what makes you stir. Perhaps it's the sixth sense you've developed — that inexplicable connection to Sherlock you sometimes feel and hope that you _wished_ was just your imagination because it's frightening in its intensity. You know when he's upset though he is outstandingly skilled at hiding it. Or is he? Not from you. Not from Mycroft. Is it just that for most people, the fake persona he projects that does not feel or have remorse is credible enough?

You flop onto your back after having somehow turned to your side in the chair, then rise to your feet. Only a dim night light by the door is on, so of Sherlock you just see the shape of a body in the dark. He flinches when you push the curtains open to let some moonlight in.

He'd covered his face with his hands and now he drops them an inch, shoulders hunched. In the sparse light, you can see that he's shaking.

"Sherlock?" your tired feet are a bit uncoordinated after being pulled out of rest, but you're by his side in an instant.

The monitor above him on a shelf begins to emit a warning. Not an emergency one, though — just something to alert that he's approaching tachycardic. Sinus rhythm, though. The BP which has cycled several minutes before shows a perfectly normal reading and you reach up to mute the warnings for two minutes. There is no change in his oxygen saturation which remains normal, yet you can hear his breathing is off. It's shallow, fast, ragged.

He pulls up his knees under the duvet, curls his arms around them.

"You alright?" you ask though you know the answer already, and just as you'd sensed he was awake, you can tell this isn't the valve giving away, not something new wrong with him physically.

"J––john?" he asks, voice wavering, "you have–– have to _restart it_ ––"

"Restart what, lo––?" you swallow down like a bitter pill the endearment that almost slips out. Almost. You can't let such things slip out. That's not what you and Sherlock are about.

"I don't want to die," he manages. He's hyperventilating properly, now.

"I think you had a nightmare," you suggest feebly, concern twisting ropes around your chest. _Maybe it's the medications_ , you wonder. After the nerve block catheters were removed yesterday, he's needed larger doses of oxycodone. They make him take short naps throughout the day, from which he jolts awake often very suddenly. Falling asleep seems to happen at the drop of a hat, too. "You're fine. Sherlock? It's alright."

His lips are trembling and suddenly, he starts frantically unbuttoning his pyjama top, trying to get at the wound there, covered by a dressing.

" _Sherlock_ ," you command in a voice you're only used with him and in the army. "Listen. No," you tell him and grab his wrists, " _listen_."

Finally, he stops fighting you and freezes. A part of him seems to register your presence. He draws a ragged, deeper breath and closes his eyes. Now that it's quiet, you are both hearing the steady but fast ticking of his new valve.

"That's your heart," you whisper. "It's fine. You just had a bad dream, I think."

What had it been about? You know better than to ask. The way he's coiled into himself telegraphs both embarrassment and fear. He hates it when his logic betrays him.

"Never had them on morphine," he says, and stretches out his feet again.

"You think it's the oxy?"

He shrugs; a small, jerky movement of his bony shoulders.

"You think you could get by with smaller doses, now? Or with just the paracetamol and the naproxen?"

You're doubtful he could, since the oxy doses were just raised when the nerve block wore off. Sternal incision gives him trouble, even when just breathing deeply or turning in bed.

You hate seeing him like this, long to help him sleep by offering something, anything, but you know you shouldn't be encouraging him to rely on medications for rest. He needs to be weaned off of all this eventually, but right now you'd give him anything that was in your possession to banish the panic and pain though your mind also whirls with relapse risks and securing the flat in terms of finding potential old stashes. You need to be there for him vigilantly long after he's discharged, help him when a moment might arrive when the temptation is a bit much after being dosed with legal opiates for weeks. You know all this, but you can't bear to see him in pain of any kind, because he deserves it less than anyone.

You know he's had more of it than _anyone_ deserves, because you've always sensed it in the way he carries himself, in the careful way he exists around others. Why else would he have given in to addiction in the first place? Just boredom? No.

He turns to his side, facing away from you. This has nothing to do with whether he needs more company; it's an escape from the scrutiny, from the mortification of someone witnessing a weak, confused moment.

You put your palm on his arm, give it a stroke towards his shoulder. He doesn't react. He's warm, alive under your fingers, and you long for more of his skin against yours. You tell yourself it's because you long to comfort him, not for your own selfish reasons.

"Go home," he says after a moment of silence passes. He doesn't do polite, so you assume he's moved on to self-loathing now, wallowing in how he might think he's burdening you, worrying about how your image of him might be changed by the sight of him right now.

You give his shoulder a squeeze, then slowly retreat your hand. "I don't think so. You might think I should go, but I don't want to. And that's my choice, not yours."

You turn on the telly and retreat to your chair, pretend to watch some disaster movie full of scientific mistakes; you know Sherlock would delight in pointing out if the two of you were watching this at home.

He eventually shifts to his back, remaining as quiet as he's been, but something makes you glance at him. A slight sheen of sweat has appeared on his forehead, and his breaths are shallow, careful.

He has squeezed his eyes shut, his forehead scrunched up in concentration.

You open your mouth to ask if he needs more pain meds.

Somehow, as always, he can predict your words before they're formed. "Wait," he says, voice guttural and low and harsh as he rides the ache.

It takes longer than you'd like for him to settle, for his breathing to even out, but you can sense an inquiry into his well-being wouldn't be welcome.

"Help me up," he says, eyes blinking open. "I want to stand."

"I don't think you should be getting up. You've only just gone to the hall and back today," you point out, omitting the fact that he went there under supervision of a physical therapist and with the help of the walker that's now parked by the door.

"Isn't it what women in labour do, walk off their pain?" he grouses, but there is a challenge in its undertow.

"I think you need more meds first. We could do this in the morning?" you suggest warily, aware that when Sherlock gets an idea, he never lets go of it.

" _Now_."

Maybe the nightmare has made him a bit claustrophobic, and that's why he wants to get up. He won't have enough energy to walk far, you remind yourself. He can't get hurt taking just a few steps, can he?

You watch him grunt and gasp as he arranges himself onto his side. You remove his pulse ox, grab his IV bag, which you'll hang off the pole attached to the walker. There are no infusions needed now, so no need to unlatch any pumps. The monitor has a small, detachable subunit which you can carry or hang off the walker. You place your right hand under Sherlock's bony shoulder against the bed, and he grasps the side rail with his other hand. You know he can't pull with much strength since it's murder on his sternum, so he needs yours to lift him up to sitting. Your left hand helps him slide his feet off the bed.

You give him a moment, watching for signs of dizziness. He grits his teeth but doesn't go pale. You fetch the walker which gets a murderous glare, but he doesn't protest — he knows he can't manage without. You lift the pair of periwinkle blue slippers — he told you that's the precise colour — from underneath the bed, but he shakes his head. You hope he won't slip in just thin socks on; he'd adamantly refused to wear hospital-issue ones, opting for his favoured brand as delivered by Mycroft.

He gasps when you help him up to a standing position. Even just a week of not using his legs and having to spare all his physical reserves to healing his heart have decimated his muscle strength. He shakes like a newborn calf and grips hard the walker handles as you hang up the IV bag and the portable monitor.

Slowly, he makes his way to the door and back. Doesn't ask you to even open it. He's breathing hard, tears prickling the edges of his eyes once he's back on the bed. Once again, he declines an offer of more pain meds, and you wonder why. Is this some macabre exercise to try to prove something to himself, or to you? An act of defiance, maybe? For someone like Sherlock it must be a profound humiliation not to manage even a short trip outside his room, and he chose to ask for your help instead of doing this when you were absent.

"I didn't want any of this," he says quietly, eyes closed after he's back on the bed, you've reattached everything and covered him to the waist with his blanket.

"Nobody asks for this stuff. Not your fault. We just have to get through it."

"You're not getting it. I didn't… I never expected it. Never prepared for anything like this."

The physician part of you wants to flee, wants to hide behind the concrete skills and knowledge you can offer and dismiss the rest as esoteric things belonging in the realm of psychiatry and psychology. It's not your area, not your division, and Sherlock is not your patient.

You understand what he means from experience, though, and that's why you know you have to stay, why he's telling you these things. It's exactly what you'd thought to yourself in the military hospital in Afghanistan and back home after. That this wasn't what you signed up for, that your career wasn't supposed to take such a beating. That it could have, should have been someone else. Sherlock has been flung a curveball by fate, and now he has to drag himself through a gruelling recovery without having any say in the matter.

"There's such a huge difference between before and now. Hard to see how to bridge the gap."

"You can. You _will_ ," you promise. This is something which you can support him with, help him achieve; you couldn't help him initially because no one but a cardiothoracic surgeon could, but there is a role for you now. "Most people who go through valve surgery don't have the benefits of your age and your fitness level."

He scoffs: a brittle, hollow laugh that is more mocking than joyful. "What fitness? I can't even make it to the loo and back alone."

"That's what makes this part of physio nice, you know. Fast, concrete progress. In two days, the loo. Who knows, maybe by next week you can get all the way to the cafeteria."

He rolls his eyes.  
  
  
  
  


**Notes for the Chapter:**

> HDU = high dependency unit. These are for patients who don’t quite need intensive care, but still more monitoring etc than what is available on a regular bed ward.
> 
> Temporary pacemaker = these wires are often left in to facilitate easy correction of persistent or life-threatening arrhythmia without needing to sedate the patient; the current required through these is much smaller than through an external defibrillator.
> 
> the sound of an artificial valve = yes, the ticking can sometimes be heard even without a stethoscope
> 
> The schools mentioned are real ones. Abingdon House School & College is an independent day school for students with specific learning difficulties such as dyslexia, ADD/ADHD, autism spectrum or social communication difficulties.
> 
> naproxen = a non-steroidal anti-inflammatory; some research points to it being a bit safer for patients with certain heart problems or a heightened risk of GI bleeds than other NSAIDs. The use of non-steroidals should be minimised or avoided when on anticoagulant therapy.


	9. A Setback

The continuous sound of the shower is interrupted by someone stepping under the spray and then you hear an almost obscene groan which makes you grin. Sherlock has now spent two days at the regular ward and finally been giving the green light for a shower. The usual recommendation is to wait longer both because there's a risk of it being too exerting and the wound has not closed yet, but with some ingenious taping and plastic bits by Helena, Sherlock's day shift nurse and a bit of pressure from Mycroft towards the ward doctors, their patient has been given the green light. You know how much it means to him — not being able to maintain personal hygiene to his standards has been driving Sherlock barmy.

Helena walks into the room, flashes you a quick smile and then slips into the bathroom. Sherlock had, at first, adamantly declined help with showering, reminding both you and the staff that he's walked two flights of stairs with the physical therapist today without passing out, so a shower is hardly going to be his undoing. However, when it comes to washing his hair, he is forced to accept Helena's assistance. The state of his hair has been torture for him, because his appearance is his asset, his weapon and his protective armour. His shampoo and conditioner have been brought in from home as well as a long list of other supplies, some purposes of which you can only guess at. Most of the space in your shared bathroom at home is taken up by Sherlock's various hair products. You wonder is Helena knows what to do with all of them; Sherlock attempting to style his hair right now carries the same issue as with washing it — the pain and the instability of his sternum won't allow him to do anything with his hands raised high enough.

Once done with his hair, Sherlock promptly evicts the nurse. You suspect he wants a bit of privacy after having so little of it for days. You leave him to it for a few minutes — that's how long you manage before getting too antsy and getting out of your armchair.

"Don't overdo it," you remind him through the door, left ajar for safety reasons. "The warmth will dilate your veins and––"

"––lower my blood pressure. Honestly, John, have you so completely failed to notice my extensive knowledge of human physiology?"

"Nope, but you often elect to not notice what goes on in your physiology, and it's the first time after the surgery you're doing this."

"It's a _shower_ , John, not the London marathon."

You almost protest that for someone who's just had a new valve stitched up into their heart, the analogy isn't far off. In the end, you decide to stay silent, because you want to give him a respite from others trying to get him to understand his current limitations.

Denial is still his go-to strategy, and he'd insisted he didn't need physical therapy. After an initial skirmish with the cardiac unit's PT, he seems to have adopted the sessions as a concrete way of proving to everyone how he's going to bounce back from all this any day now. He's had a shouting match on the phone with Lestrade over how long he'd be sidelined from on-location case work; the DI had argued sensibly that what Sherlock does is the equivalent of any high-ranking Met officer, and if Greg wouldn't be signed off to come back to work for months after open heart surgery, then Sherlock shouldn't be, either. Sherlock had tried to convince Mycroft to get an MI6 physician to sign him off sooner, but his brother had sided wisely with the detective inspector. Mycroft, more than anyone, must know what level of self-deception Sherlock is capable of when it comes to ignoring the needs of what he calls dismissively his Transport.

Today has been his best day so far in terms of mood; perhaps the promise of a shower has helped. He's been more energetic than lethargic and has even acted out at the staff much less. He's taken his medications without protest, accepted your offerings of a delivered lunch from a nearby Thai restaurant with open delight, and shouted at the telly, which he'd finally agreed to watch to waste some time. Still, as glad as you are that he's less cranky, you can't help but worry about the fact that he's acting more like a hotel patron than a patient, waving off any discussion of his infirmity and ignoring reminders to take it easy.

Still, you'd do anything to make things better for him, including indulging his self-denial if it gets him a nice, relaxing shower.

When he emerges from the en suite some fifteen minutes later — he hardly gets it done at home in less than twenty — you put down the paper and give him a once-over. He's flushed from what must have been hot water, skin pink-tinged and steaming. He's wrapped a towel around his waist underneath a short hospital bathrobe and is using another clean one to squeeze gently what he can reach of his hair to dry it. You've noticed he never rubs or combs it after giving it a wash, only scrunches it inside towel-covered hands. He's not lifting his elbows very high — doing so would stretch his sternal incision — and his movements are careful, considerate. Clean water doesn't really harm a surgical incision, but since his extends down all the way into his mediastinum, it had still been covered with a waterproof adhesive which will be changed once he's wearing a fresh pair of pyjamas.

He's breathing a bit heavier than before, clearly winded, and quickly makes his way to the bed, dropping down to sit on the edge. After an apprehensive glance at you, you see him go a bit pale and lean forward as though wanting to put his head between his knees.

"Dizzy?" you ask, already on your feet. "Lie down a bit, we'll get your legs up."

He's blinking, a deep V of a frown forming between his brows. You support his back as he lowers himself onto the bed — were he on his own, he'd need to do it side-first to prevent aggravating the incision. He seems… frozen? Concentrating hard? You notice the veins on his neck are distended, which can be explained by the shower's warmth, but the pulse pounding there as the carotid artery shoves the jugular vein is very fast and irregular.

You grab two pillows from a table nearby, lift his feet one by one onto them. He can't do that himself since it would strain his abdominal muscles and chest too much. There's so much that he can't do very well yet, and even just the lighter PT exercises require extra doses of pain meds.

"Sherlock? Give me your hand." You're used to analyse the pulse from the wrist, that's how you were taught, instead of just watching the neck. This is what you've got available right now without getting the blood pressure meter from the cupboard.

His pulse is fast — _very_ fast and irregular. "How do you feel?"

"I felt it change," he admits. "When I stepped out of the shower and felt a bit… out of it."

You notice that his bare ankles, revealed by the short bathrobe, are not swollen, thankfully. "Any shortness of breath?"

"Now, but it's… it feels strange, like something's tickling my throat. A lump of sorts, when there are two beats close together."

He's not being constantly ECG-monitored any longer; they get a short paper film every morning with the labs, plus there's BP and saturation measurements every few hours. They need to be redone, stat. You press the call button.

"What is it?" Sherlock asks, and his eye are so wide and alarmed that you realise you haven't explained any of what's been going on in your head to him, and he's the patient.

"I think it's A-fib. You had it right before surgery. Nothing life-threatening," you scramble to reassure him.

"How do you know it's atrial?"

You keep forgetting that his extensive theoretical knowledge doesn't mean that he is familiar with the clinical side of medicine. "With V-fib, you wouldn't be having a conversation with me and, as I said, you've had A-fib before."

"The new valve was supposed to fix everything."

"It's not uncommon," you try to promise him. "It's definitely connected to what your heart's been through. It can probably be reversed back to––"

" _Probably_? Not _uncommon_ — nor is _death_ ," Sherlock snaps, eyes blazing with anger. He looks as though you've betrayed him, somehow.

"You've done so well so far. I'd be surprised if there weren't any hitches at all, considering how badly you were in heart failure."

"I'm not _now_!" he snarls at you, colour back on his cheeks. He snatches his wrist back indignantly; you'd forgot you were still holding it, monitoring the beats. "They said it didn't last long enough to leave permanent damage! They told me at the intensive care ward that all signs of dysfunction were receding! God, you lot are all the same; liars and conspirators just so you could have it your way," he scoffs.

"And what way is that? You, with a repaired valve, feeling much better?"

"How is this _better_? I feel like someone's pounding on my ribcage, and I just nearly passed out from _having a_ _shower_! How is this _better_ , you idiot?!"

You pinch the bridge of your nose, praying that his nurse would show up soon and get things going with hooking him up to an ECG monitor. "Getting worked up isn't going to help."

" _Worked up_? Am I some sort of… _patient_ now?!"

The question leaves you gaping. "Of course, you're a bloody _patient_! What else would you be, or is that somehow beneath you?"

"This wasn't the deal. I was told that there'd be surgery, which would _fix this_." He pushes open the lapels of his bathrobe and starts peeling off the adhesive dressing. "I want to see it. I want to see what the _hell_ they've done to me."

Whenever nurses have changed his dressings or rounding surgeons have wanted to see the incision, he has refused to look at it. Avoided it like the plague. Now, angry and clearly a bit fearfully startled by what's going on, he wants to have a look. Not a good idea.

"Sherlock, wait––" you try, but the glare he gives you could melt concrete.

You swallow, realisation dawning. This must be the reaction you've been expecting, the storm you've smelled in the air, the dark clouds in the horizon finally covering the elusive sun. Mycroft had anticipated as much: two days ago, he'd told you to just wait until it really sunk in with Sherlock what had happened. ' _He'll get there eventually_ ,' the older Holmes had stated dryly in the corridor outside Sherlock's room as you and he listened to Sherlock arguing with a phlebotomist he considered utterly useless. ' _When a moment arrives when he cannot escape from reality into complaining about irrelevant things, and that is when he will truly start his recovery_ ,' Mycroft said with the conviction of a man speaking from experience.

A sickening pity and overwhelming affection making your own heart pound in your ears, you watch as Sherlock rips off the last of the bandage.

As surgical incisions go, no one would describe this one as subtle or aesthetically impressive. It extends from his sternal notch to nearly the blade of his xiphoid process; the skin is puckered and furled where its edges have been pulled together. It nearly looks like the edge of a pie crust. Initial swelling has left scabs of tissue fluid and blood onto the staples, which the shower hadn't washed away since the wound had been covered meticulously.

Sherlock is staring at the incision with a mixture of horror and disbelief as Helena opens the door. You tell her an ECG is needed; at least a strip should be recorded, but restarting continuous telemetry would be even more advisable. She takes Sherlock's blood pressure with the manually operated meter from the cupboard — he hasn't had an arterial line for that for days. His oxygen saturation is normal, his BP is a bit on the low side but not alarming. No need for supplemental oxygen or vasoactive medications, at least not yet. The portable pulse ox shows a fast, irregular rhythm.

"I'll call Dr Stamford," Helena promises.

As a personal favour Mike had volunteered, he's handling Sherlock's case though he's usually at the outpatient clinic or consults for the A&E department instead of handling things at the ward.

Your eyes trail Helena as she leaves to make the call. When you turn to face Sherlock again, you're astonished to see that he's heaved himself into a sitting position again. His bathrobe hangs open, the incision uncovered. Helena had promised to bring in something to cover it again. He's taken off the pulse ox, pushed off the BP cuff.

He rises onto shaky feet, grimacing painfully. "I'm not waiting for Stamford. I'm getting out of there."

He goes for the wardrobe in the corner, housing some of his clothes and coat and leather Oxfords as delivered by Mycroft. You'd asked the older Holmes if it wasn't a bit early for all that, and now you wish you'd protested properly. The explanation had been that Sherlock had asked for those items.

"What? Sherlock, no!"

"Make yourself useful and get me the self-discharge forms." He buttons his pyjama top with fumbling fingers, leaving the incision uncovered underneath.

You know he can't really dress himself without help yet, but he looks hell bent on doing just that. "Sherlock, stop, _please_!"

Perhaps it's that final word, or your desperately pleading tone, or the fact that you've now wedged yourself between him and the wardrobe that makes him halt. He sways a bit, and you grab hold of his arms.

"Back on the bed. _Now_." You've used your Captain Watson voice sparingly with him, not wanting to dilute its power. The intensity of its effect on him has always been strange and exhilarating, and now, that tone is definitely called for.

He shoves you weakly in the chest to loosen your grip. " _Useless_ , all of you. You _tricked me_ into this."

"We didn't trick you! You were… Sherlock, your heart couldn't have taken much more."

"You never asked me if this was acceptable, to become some… some…" he shakes his head.

"Just sit down," you plead, suddenly feeling the weight of the past week heavy on your shoulders. "Just… let's just get that ECG done and then have a talk on what to do. You trust Mike, don't you? You trust me, at least?"

He's looking past your shoulder, eyes an angry, determined line. Maybe that's your answer. He doesn't even trust his body right now, so how much trust could he spare for other people?

"One thing at a time, yeah?" you try, desperation creeping into your voice. "You can leave at any time later. Let's just see what's going on."

Helena comes back in and is taken aback by the sight of Sherlock out of bed and looking as angry and pale as he is. "Is everything alright?" she asks, approaching the two of you, ready to take Sherlock's arm.

" _Get_ _away from me_!" he snaps.

You give her an apologetic glance. "It's not okay, but it will be. Did you get a hold of Stamford?"

"He won't be a minute," she promises, "and the tech's bringing a monitor round. I'll need to attach some electrodes, and we need to cover that incision," she tells Sherlock as the two of you help him back to bed.

You don't need to wait for Mike to make the diagnosis. The minute the monitor's graph comes to life once Sherlock has a neat row of electrodes on his chest, you see the telltale narrow, irregular QRS complexes surrounded by erratic, static-like P-waves which signal chaotic, fibrillating atrial function.

"It is just A-fib. We'll fix it," you promise, feeling as though you're holding a live wire as you address Sherlock who's sitting on the bed, legs off the side, still looking ready to leave. He refused to lie back down.

" _'Just'_ A-fib," he grouses. "You can have it, then, if you think it's nothing at all."

"Not what I meant."

Mike clatters into the room with his ultrasound machine, accompanied by the registrar assigned to the ward this week.

"Not interested in being gawked at again with that thing," Sherlock declares, cocking his head at the ultrasound. He looks ready to detonate again if someone says the wrong thing. The room being so full of people is clearly setting him on edge.

"He got a bit winded, blood pressure dropped after his first shower," you explain, "rhythm irregular and fast so I assumed A-fib, which just got confirmed. Lie down so Mike can have a look."

Sherlock gives you a venomous glare but lowers the bed down with the remote.

"BP's fine, now," Mike comments as he glances at the latest reading on the monitor. A BP cuff and a pulse ox clip have been attached along with the ECG electrodes.

"What about shortness of breath? Any chest pain?" Mike asks Sherlock.

" _No_."

"Mitral valve problems put a lot of strain on the right atrium. Not surprised that this would happen now that you're being more active. We'll do a cardioversion if you're sure you noticed when it started, and get you on some antiarrhythmic meds, at least for now. It's a good sign this only happened now and not right after the operation."

Sherlock looks like he's not buying a single word.

"When did you last eat?" Mike asks Sherlock. "If this only started now and you're otherwise feeling well enough, we can reverse it back to sinus and then do the echo."

"Do it," Sherlock commands. "Reverse it. But I'm not consenting to anything else."

Mike looks a bit put off. He's probably confused why Sherlock is being so thoroughly uncooperative. "I'll give a ring to anaesthesia; their morning cases should be well underway by now, so I'm sure someone is available."

"Anaesthesia?" Sherlock's eyes narrow. "Available for what?"

"It's just a short GA, ten minutes tops, no need to secure your airway––" you start explaining to him. A cardioversion which means giving a synchronised electric shock to the heart to revert its rhythm, would be too uncomfortable and alarming for an awake patient.

Sherlock's hands clamp like a vice to the edges of the bed and with an agonised groan, he turns to his side and then pushes himself to a sitting position. "I'm done here."

Helena walks in at that moment, a fresh, sterile dressing still in its packaging in hand. "Um, Mister Holmes––"

You've had it with this circus. "Sherlock, _what gives?_ We can fix this; you can't just walk out of the hospital in your pyjamas with a heart rate of a hundred and ninety."

"I can do whatever I want, despite what you people think. _Fix it_? You've done quite enough!"

Enough is what you've had, too. With a move rehearsed long ago and seldom used since the army — and one Sherlock is certainly not expecting — you shift behind him, lock his arms behind his back and bring your mouth close to his ear. You know this must hurt his chest, but maybe the pain will snap him out of being an irrational arse. "Get. back. _on the bed._ "

You hold on until he yields, then do your best to be as gentle as possible in helping him back onto the bed. He won't look at you. It tears at you, having no idea what to say to make things better. Everything you say or do seems to be the wrong thing.

"I'm not having the GA," Sherlock tells Mike.

"Well, GA is the way it works, really; we can't give you the shock without anaesthesia, it would just be…"

"What about Brinavess?" the registrar pipes up.

Mike turns to face him with a reserved smile. "It can elevate the risk of other arrhythmias, and house practice is to reserve it for patients with difficult airways…"

"Mike, a word?" you ask. "Sherlock, stay," you command, and he rolls his eyes at you. He'd cross his arms if it didn't aggravate his incision. At least he allows Helena to start redressing it.

You drag your old medical school friend into the corridor. "If there's an option he'll agree to, make it happen," you tell Mike.

"There is vernakalant, yes — Brinavess is the brand name — which is an infused drug that can be used to reverse A-fib, but an electric cardioversion is safer and faster, and I'm not sure I could even get the drug authorised since he's not a difficult airway."

"If what's coming out of his airway right now doesn't make him difficult, then I don't know what would," you scoff.

Mike replies with a joyless smile. "Yeah, you're right. And since he declines the GA, there's not a lot of options left. Just trying to control the ventricular rate might not reverse the rhythm––"

"––and the longer it lasts, the more risk there is of a complication." Sherlock is on a heavy regime of anticoagulants, making it unlikely that a clot forming in his atrium because of the A-fib could travel to his brain, but knowing how he values that organ, you know he wouldn't put up with even a marginal risk.

"I think he'll walk if we try to push GA on him again. I have no idea what his deal with that is right now, but I think he's just… overwhelmed. And disappointed," you explain.

"I'll ring out department head, see if we can get the approval. I'll say he declined GA, so we have to go for the next best option."

"Thanks, Mike."

"Thank you, really, since you're the one bearing the brunt of this. How are _you_ holding up?"

What does it matter? You can't crumble or take a timeout. He needs you. You're alright, because you have to be. "I'm fine. Can you do the Brinavess here?"

"We'll need to move him back to the CCU."

"Fuck." Yet another thing that will send Sherlock reeling since it's a concrete step back on the road towards discharge. "Can't he be monitored here?"

"These are temporary quarters for the unit; we don't have remote monitoring, just temporary telemetry for which whoever reads the data has to be in the same room. That portable monitor we just brought in is the only one we've got so we can't reserve it for long. It's got to happen at the CCU, because he'll need an antiarrhythmic drug added to the regime afterwards, and since he's just out of surgery, he needs close surveillance at least for twenty-four hours."

"Antiarrhythmic? Like a beta blocker?"

"Yes, to control the heart rate, but in his case, to prevent further episodes, I would recommend amiodarone as well. We'll start him on those once the vernakalant has done its job."

Sherlock had even protested the warfarin which cannot be avoided with a mechanical artificial valve. That's what he keeps calling rat poison — technically, he's correct since warfarin is still used as such. And now there will be the nerve-rackingly hard sell of two more drugs he'll have to take for God-knows-how-long.

 _One thing at a time_ , you tell yourself. You just need to talk him into agreeing to be moved back to the CCU.

While Mike disappears to call their unit head, Sherlock's eyes lock onto you the moment you return to the room.

"Corridor conferences, eh, since I can't be trusted with information about my own health? Taking lessons from the British government, John?"

"There's a drug infusion which can replace general anaesthesia and the shock. You'll need to be at the CCU for that and stay there for some time afterwards. There will be some additional meds you need to take to prevent this happening again," you tell him as calmly as you can.

He turns on the bed, facing away from you and Helena. "Fine," he mutters.

It's not because you have the nagging feeling of arriving in the false calm of the eye of the storm.

**Notes for the Chapter:**

> Sherlock would likely not be allowed to shower this early after such surgery, but we know how persuasive the Holmes brothers can be…
> 
> (Emergency) defibrillation is not the same as cardioversion. The latter is a planned, non-emergency procedure in which the defibrillator is synced with the patient's heart cycle to avoid triggering more dangerous arrhythmias than atrial fibrillation. The amount of electricity used in a cardioversion is also modest compared to cardiopulmonary resuscitation. It's one of doctors' pet peeves everywhere that medical TV dramas and movies often show asystole being defibrillated. That's against recommendations. The only rhythms that are to be defibbed during CPR are pulseless ventricular tachycardia and ventricular fibrillation. Atrial fibrillation is not life-threatening as long as the heart rate is reasonable and doesn't lead to heart failure. Even when well-managed, it does still shave off about 30 % of the heart's pumping ability. For full force, we need the atriums to contract steadily and purposefully too, not just the ventricles. In A-fib the left atrium is just jittering uselessly.


	10. Talk to Me

**Notes for the Chapter:**

> I am sooo behind on replying to all your wonderful commentary. The [fourth episode of What The Fic?! with J. Baillier](https://www.youtube.com/watch?v=hMUuod8Emsk&feature=youtu.be) swallowed me whole in terms of enthusiasm, so I hope the end result of that and this latest chapter with soothe the sting of unanswered comments section communique.
> 
> (links to all of the episodes of _What the fic?!_ can be found [here](https://jbaillier.tumblr.com/tagged/what_the_fic))

Once wheeled back into the HDU section of the Cardiac Care Unit, Sherlock is quiet. He seems to be just gritting his teeth to get through this and back on the track he thought he was on with his recovery. He seems suspicious and cagey about everything that's being done — monitoring re-established, infusions being prepared — as if he hadn't very recently been subjected to much more invasive and intense care at the ITU. He's not allowed food or drink for the time being, just as a precaution, and when informed of this, he makes it clear the rule is ridiculous since he won't be consenting to any sort of anaesthesia, anyway, even if the Brinavess doesn't work.

Something about this doesn't seem right. The thing with Sherlock is that sometimes, when he most vehemently denies something being wrong, he ends up revealing himself in other actions. On a surface level, he just seems profoundly disappointed by this setback, but the detail of how adamant he was against sedation or a short GA sticks out. He's never had any trouble with or objections to general anaesthesia before; you even know he's declined a spinal block and another nerve block for various fractures before in favour of the oblivion of GA.

After being prompted several times to lie back down and relax, he finally settles down onto the bed with your help. As the CCU nurses begin hanging up fluids, programming infusers and adjusting wires, towering over him, you see him squeeze his eyes shut, his breathing now shallow and rapid.

You call out his name and his eyes fly open, drinking in the sight of you. Clearly, the distraction is welcome.

"Mike says the Brinavess is well-tolerated; it can cause some extra beats but generally there isn't even a significant pause when the rhythm reverts," you tell him.

"Why don't they use it on all patients, then?"

"Like any antiarrhythmic drug, it can have side effects, particularly in combination with other heart drugs," a nurse replies.

"Plus there's the cost," you point out, "and safety — electric cardioversion is very safe, except if the patient hasn't been nil-by-mouth or has a difficult airway. Much fewer side effects than drugs."

Sherlock looks unimpressed with the statement. "Is that it?" he asks, eyes now fixed on an infuser pump. "Why isn't it on yet? Why are they wasting so much time faffing about?" His tone has risen in pitch, exaggeratedly indignant.

"Let them work, Sherlock."

You find yourself wishing the nurses would finish their preparations, too, because you want to talk to Sherlock without interference. You're steeling your nerves, preparing for battle because you know he'll try to deflect, will attempt attacking you because he doesn't want to discuss things that bother him. But he's been through so much, and Mycroft is right — the stress and anxiety and shock are bound to come out at some point, and you'd rather cushion the impact than let him freefall.

You get a text, assume it's from the locum agency asking about your availability.

It's not.

' _Regrettably, I am delayed by a meeting. Please escort Sherlock's visitor in from the CCU extrance. MH'_

What visitor? How does Mycroft knows Sherlock has been moved to the–– oh neverthebloody mind! _He's probably planted some former-nurse-turned-MI6-agent somewhere_ , you grumble in your head as you rise to your feet from the chair beside Sherlock's bed.

"Where the hell are you going?"

"I won't be a minute. You've got a visitor."

"If it's Mycroft tell him to crawl back to whatever chute to hell he climbed out of."

"It's not him," you say, but you can't answer with more than a shrug to his sceptically inquisitive look regarding the precise identity of the visitor.

He calls your name to your receding back, but you've been summoned so off to the entrance foyer you go.

There stands Mrs Hudson, glancing around with a strange sort of determined confoundment. "John!" she calls out instantly upon seeing you and begins the approach which ends in a bone-crushing hug. For her age and frail size, she is strong.

"They told me at the ward to come up here. They said there was a note in Sherlock's file to allow–– oh, John, how is he? Is there a complication? Is that why they moved him?"

"I don't know if this is the best time to visit."

"Oh, rubbish! Isn't that when people need company the most, when they're worried and things are happening?"

You purse your lips. Sherlock has never really pushed her away, never declined her support for anything. You have a hunch she's the one he talks to about things, not you or his parents. Maybe this'll do Sherlock some good, and Mrs Hudson has certainly proven that she was weather even his foulest moods with grace.

"It's nothing life-threatening, but there's some arrhythmia, and he's not happy about it."

"Of course he isn't! So careless he is when it comes to looking after himself. Thank heavens he found you and dragged you home. Lead the way," she prompts — more of a command, really.

The idea of Sherlock grabbing you by the lapels at Barts and dragging you to 221b quirks up a smile that has been absent from your features all day. He saw you and wanted to move in together. What would he have said if you declined? Would it have been yet another entry in a long catalogue of rejection? He made such a show of trying to be nice and cheery that day, snapped at anyone trying to sour your opinion of him. He really wanted you as his flatmate. Why? He's normally a reserved person, very slow to warm up to people. Assumes they're all idiots until they make the effort to prove otherwise.

"No hugs," you remind your landlady. "He's got a big incision on his chest."

Sherlock gets a double-peck on both cheeks, instead. When she unceremoniously pulls the curtains aside, Sherlock's surprise and dismay fade rapidly. If anything, he looks relieved, even relaxes a bit, and you know you made the right call letting her in. Even Mycroft seems to agree.

There's some obligatory cooing and empathetic exclamations of Sherlock's state which he listens to with only half an eyeroll. She takes the chair while you stand vigil at the foot of the bed. Still atrial fibrillation, but perhaps they've started the beta blocker since Sherlock's heart rate is down to ninety per minute.

"How are you holding up? John says there's some rhythm problem, now?" she interrogates.

Sherlock is looking at his lap and sighs. "Whatever I expected this was going to be like, I didn't… I didn't have _time_ to expect anything."

"It was all very sudden, wasn't it?" she pats his arm, and he doesn't pull it away. She's one of the only people allowed to touch him without warning.

"Doesn't exactly help that people here just assume I'm just going to accept it all and agree to whatever torture they want to inflict."

"I'm sure they're all just trying to help, and you've got John here making sure you get the _best_ care," she promises. "Isn't it nice to have a live-in doctor? I feel so much safer, having him in the house."

Knowing Mrs Hudson, this could be more of a reference to your gun than your medical skills, but it's nice to get some praise for a change. All you've had in the past week are insults.

"His perspective is skewed by his profession. If something _can_ be done, then it _should_ be done, regardless of what the patient wants. He doesn't get it."

Mrs Hudson frowns, and that frown then deepens into anger as she tilts her head and pins him down with her stern gaze. She would have made a fine schoolmistress. "What on earth do you mean, that John wouldn't get it? That's nonsense."

You cross your arms. You're jealous of her ability to cut right to the point with Sherlock, and have such power over him that he won't instantly side-step and evade. "I'd like to hear this, too. What don't I get? That it fucking sucks, needing emergency surgery? That recovery is slow and painful and frustrating and being in a hospital is hateful, as you'd say? What don't I get, Sherlock?"

"John of _all people_ should know what it's like," Mrs Hudson lectures. "He got _shot_! He lost his career and frankly, he looked quite dreadfully depressed and a bit unpredictable when he came to see the flat––"

You exhale. "Mrs Hudson––"

"He absolutely knows what it's like, Sherlock, he _must_!" she insists. "Wallowing and taking it all out on him isn't going to help."

"What would help is if they did what they promised and _fixed it_ ," Sherlock forces out from behind clenched teeth. "You're all acting as though I made some choice and now regret it. I didn't ask for any of this, regardless of what Mycroft thinks."

Mrs Hudson looks momentarily confused, then seems to decide to ignore what Sherlock might be referring to about the past. "Everyone avoids things. I've my hip, and it's been ripe for a replacement for over five years, but I just… I know it would be better, but most days I just think that I'll manage, because going through the whole thing, surgery and hospital and all, that would just be so _much_. I don't enjoy being my age, I really don't."

This seems to give Sherlock pause. A tendency for using avoidance and denial as a coping mechanism might well be behind him not attending his follow-up appointments after the endocarditis, and maybe he started using again. Still, Mrs Hudson has a point — often, people know what they're supposed to do in terms of their health and what's for the best, but they just don't want it and fight against it in irrational ways. Such as trying to go MIA from a cardiology ward with a heart rate of nearly two hundred.

"If you came here to lecture me, kindly _leave_ ," Sherlock says, but with little conviction.

"I came here to see you and to be your friend like John. And sometimes a good friend says what needs to be said," Mrs Hudson points out.

"If only he'd listen," you mutter.

Sherlock looks taken aback by this. "I listen to you all the time," he says, clearly upset.

You feel whiplashed by how affected he is by that accusation. "Doesn't feel like it when I'm being called an idiot."

"I stayed, didn't I?" he asks, and sounds as though he expects a medal for it.

"You stayed because it was the rational thing to do." You're not going to take credit for it because nothing you've said lately, he seems to have believed or accepted.

"You both look absolutely wrung dry," Mrs Hudson points out. "Easy to say things you don't mean when you're tired and poorly. I'm sure John understands," she says pointedly, now looking at you.

"Yes, I do," you confirm. "I'm still embarrassed by how I treated some of the staff at the rehab I got sent to after Afghanistan." _I just wish you'd talk to me and not just use me as a punching bag._ You should say it, plead him to trust you with his fears and worries, but you know that cornering him like that wouldn't help. With Sherlock and the emotions he has too many of and doesn't know what to do with, it's like waiting for a timid rescue cat to come out from under the sofa — the best way is to ignore it until it's brave enough to poke its nose out. Even one look in its direction, and it's going to pull back.

You know he's not being deliberately mean to anyone but bad people — it's just not him, no matter what he tries to project. He just… reacts, because while he's intimately familiar and in good terms with how his brain works, his heart is a completely mystery to the man. He treats it like he treats his body — ignore it as long as he can because he has no idea how to attend to its needs.

"Are you allowed to eat anything?" Mrs Hudson asks, patting the canvas bag she's brought with her.

"Not at the moment."

If the Brinavess won't work, then anaesthesia and an electric cardioversion has to be discussed again. _Oh, joy_.

"What about tea?" Mrs Hudson asks in a regretful tone.

"No."

Sherlock presses his palms to his face and rubs them down his cheeks, sighing. Mrs Hudson is right — he looks thoroughly drained.

"The new valve is doing alright, then?" Mrs Hudson asks. "Or is this rhythm thing related?"

"It is related, yes, but mostly just a residual effect from what happened before the surgery," you rush to explain. "The new valve is fine, but of course it'll take a while to grow back in."

"I should do a spot of cleaning before you're discharged," Mrs Hudson fusses; "with a dressed-up wound and a new valve, you wouldn't want to risk getting an infection. I should clean the fridge in particular," she says pointedly, casting you a conspiratorial glance.

"God, yes, please," you say, laughing. "The half a badger that's in there is well past its sell-by date."  
  


  
—————————

Mrs Hudson doesn't stay long; she clearly senses the acuteness of the situation and Sherlock's exhaustion. She leaves the bag which solves your lunch problem. You eat the sandwiches and some of the salad in the break room because it would feel like the height of rudeness to eat in front of Sherlock when he's not allowed any.

You draw the curtains tight around his bed; remote monitoring from the nurses' station allows for you and Sherlock to have some privacy. The vernakalant is infusing along with a fresh bag of fluids. Thankfully, Sherlock still has a central line; usually the large-bore one used for heart surgery is removed and peripheral IVs used on regular wards, but his larger veins are scarred and difficult to stick, so an anaesthetist had swapped the large central line for a smaller one with the help of a guidewire. It allows for bloods to be drawn easily as well as a reliable route for fluids and medications.

You hope that Mrs Hudson's visit has made Sherlock rethink at least some of his ideas about what you understand and whether he could talk to you about things. There's something about his comments earlier when he was discussing the cardioversion with Mike that's nagging at you.

Finding the right opening for a difficult conversation is always the hardest bit with Sherlock. Ideally, you'd want to catch him off guard, surprise him, lance through his defences into the emotional boil he's trying to encapsulate so he wouldn't have to look at it.

"What's with not wanting GA again? Did something happen in the OR that you didn't like?" Plain, simple, unavoidable.

"Why on Earth would I have _liked_ any of it?"

 _Fuck_. Of course you should have realised he's resort to semantics, that he'd pick apart your statement to derail the conversation. "I was just wondering if there's something else making you nervous besides just the A-fib."

"And you think a significant arrhythmia when I was promised a prompt, uneventful recovery is not enough?"

"You weren't promised that, Sherlock. What you were promised is that they'd give you a new valve because the old one was wrecked."

"And this is where you kindly, condescendingly remind me that I've had open heart surgery and that setbacks are _normal_ , and I should just _keep quiet and behave_?"

"You're mistaking me for Mycroft," you say, proud of yourself that his attempts at riling you up have not worked at all. Yet. "For the record: I'd prefer that you did let it all out, what you're thinking, instead of just bristling at me for things I haven't even done."

"Let what out?" He's challenging you to say what's on your mind so that he can dismiss it as poppycock. So that he won't have to voice what he feels. What he fears.

"There's something bothering you. I know you're having nightmares." That one incident hadn't remained an isolated one. Your exhausting level is approaching critical because, as much as you try to take time for yourself to rest and regroup, you can't leave him alone at night. Two nights ago, just as you thought the coast was clear — that he'd sunk safely into deeper sleep — some wretched dream had hit and he'd performed the bedridden version of sleepwalking, hands flailing and demanding that you or someone else _'give it back_ ', whatever it was. When you shook his shoulder he jolted awake, clearly on the verge of a panic attack, trapped between a flimsy grasp on reality and whatever horrors had gripped him in his dreamscape.

"Does it have to do with the operation?" you ask.

Sherlock is looking up and to the right where the monitor is still showing A-fib, heart rate now higher than it was during Mrs Hudson's visit. "What would be the point? You won't believe me. Nobody ever does."

"I will absolutely believe you." You rest your hand on top on his on the blanket. "I will always believe you."

His dismissive statements about medical staff as a collective seem to echo things from his past, perhaps from the days when he frequented A&E departments due to his drug use. Addicts often need such services for fractures, infections from injecting into veins, overdoses, psychotic behaviour. You can't help but send a thought out to Mycroft who'd looked after his little brother in those times, kept him alive. Sherlock, sober but ill, is a handful. Sherlock, off his tits _and_ ill or injured must have been, well, a tribulation nobody deserves to have on their responsibility.

He studies your expression, seeking further evidence that he won't be dismissed and ridiculed. Your heart aches for him for having gone through things which have so shattered his confidence that others would respect what he thinks and feels.

"I want to know," you prompt him gently, "so that I can find out what we… what _I_ could do to help."

He scoffs. "You can't fix _dreams_ , John. That's what you'll tell me they are, because there's sod all you can do about any of it."

"Try me," you say firmly. "Medical stuff is my domain, Sherlock. Even if it's all happened and can't be changed, I know stuff you don't, and I can help find out more so that you can make sense of it." Taking advantage of his thirst for data and appealing to his rationality tends to work. He doesn't like consulting others, but in medical matters, he often defers to you during the Work. He thinks you're an idiot, but at least you're a physician idiot.

He breathes out; focusing on the conversation seems to have at least made him stop watching the monitors and the infusers like a hawk on Ritalin.

"I remember things, but I can't be sure where I was still meant to be awake, or what parts of them are real. Even the bits I know can't be accurate… they feel exactly the same, and that's… out of the things I _do_ think I remember correctly, I can't work out what parts of them are genuine memories and not some sorts of dreams caused by the medications."

"And they're upsetting, these… images?"

"You make it sound as if I'm some hysteric," he accuses.

You'd tried to keep your tone neutral, to pick the right words, but with Sherlock there _are_ no right words, are there? "I really didn't mean to. Can you give me an example?"

"I was there, in the OR, watching myself, but not from… wasn't lying down. They took out my heart and put it on a table and I wanted them to put it back. You were there, and you didn't lift a finger to help even though you must've known they were doing it wrong."

"Well, I can tell you that one must've been a dream because I wasn't in theatre."

He's looking up at the ceiling. "There are these moments when I felt as though I was awake, but I wasn't… anywhere, really. Couldn't see or hear or feel anything, but I was aware of myself. I remember bits of what they did in the OR and I can't be sure whether I was meant to still be awake for them."

"Such as?"

"Pain in my neck. Pressure. Something warm trickling down. Being stuck on my wrist with something, presumably they were putting in lines. Burning in my arm, mask on my face. They were talking about me as if I wasn't there — as if they didn't know I could hear it."

"The burning and the mask sounds like anaesthesia induction — some of the hypnotics can sting. That should be normal." You have no idea what cannulations they did awake and which ones he was spared from until he had been put under.

He's frowning, eyes distant. "I remember hearing hammering for some reason. That doesn't make sense, does it? Then there was a man holding me down and your voice. I think I heard Mycroft, but only very vaguely."

"They were doing some renovations in the ward neighbouring the ITU. You woke up from sedation and were a bit… out of it. The nurse had to stop you from pulling out your lines. The sedation had been stopped; you were allowed to wake up so that was normal, too, being confused."

"There was… falling, when I remember the mask on my face. I've felt that before when put under, but this time it was… I had questions, I think, but they ignored me. I'm not sure I even said anything, though. Can't remember being taken to the OR, which is illogical, considering I'm quite sure I remember things which happened while I was _in_ there. I just… I can't stop trying to pick apart my own recollections. If I can't trust this," he points at his head, "then I can't trust myself. The first days after the operation are a mess in my head; clearly, I've been awake, I've conversed with people, but I have no idea what I've said during most of that time. I won't go through that again, compromise the timeline in my head."

It makes sense, now, why he'd decline even a short GA. Nothing frightens him more than not knowing something, not being able to logic his way out of a messy tangle of emotions. "Why is it so important to know everything that happened? Why do you want to remember?"

"I don't!" he protests, "I'd prefer to delete all of it but I can't, because it won't make sense, and I can't let go of that." He admits this with a rather mournful tone — as if feeling guilty for troubling you with such a thing.

You find yourself angered, now, by what kinds of fucking winners have provided medical care for him in the past to make him feel like a nuisance instead of the centre of his own care. That anger then turns into determination. No, you can't fix these dreams or erase these vague recollections for him, but there is someone who can help — someone who would have been there in the OR with their wits intact. Sherlock needs more data, and you're going to acquire it for him.

"Give me a minute," you tell Sherlock, and go to the nurses' station, leaning close enough to read the name tag of the nurse who'd welcomed Sherlock back to the ward. "Shirley?"

She looks up from the computer. "Yes, Doctor Watson?"

"The name of Mister Holmes' anaesthetist for his surgery has slipped my mind. We met him here before, waiting for the operation. Can you find out if he's on duty?"

"They don't really work for cardiology but for the anaesthesia unit, but I can check the theatre tracking program for you in case the name pops up," she suggests. After some clicking, she looks up at you again. "That would be Dr Marsh?"

It sounds familiar. "Yep, I think that's it."

Some more clicking around. "He's listed for an operation as the non-perfusion anaesthetist."

"Are they still in theatre?"

"Well, the bar is still all green, and they're in the middle of their designated, I mean planned, OR time. I'm sorry, that's all I can tell you since I can't open the detailed patient timestamp records without due reason. I'll try calling him."

"Thank you."

She finds a number from a rolodex. "What should I tell him?"

"That his patient from three days ago wants a word."

She makes the call, then informs you that Marsh had said he's unfortunately too busy today since he's beginning his holidays this afternoon and has instructed to request another anaesthetist for a discussion when they come to the ward in the afternoon for preop rounds.

It's understandable, but useless in terms of what you need. What Sherlock needs.

"That's fine. Thank you," you tell Shirley, a plan dawning. If Marsh isn't the perfusionist, he won't be needed in the OR during that stage of the operation. But, he would still have to be at the OR unit.

You check on Sherlock who's typing something on his phone.

"It's Mycroft, asking for a status update."

"And you're telling him what?" This should be good.

"Not suitable for civilised ears."

"I'll be right back," you tell him. "Just need to pop down to the OR unit."

"Why?"

You just give him a smirk. "You'll see."

This leaves him looking more alarmed than reassured. "I promise it'll be good for you."

He rolls his eyes. Sassing at Mycroft via SMS seems to have displaced some of his anxiety at least temporarily, which gives you an opportunity to leave the ward for a moment without worrying too much about him.

A glance at the monitor tells you the Brinavess hasn't done the trick yet. You pray to whatever god happens to be listening that it will.

_______________

Two floors down in another wing, you find the right theatre unit. The doors are locked, of course, but you hide your visitor pass and since the consultants all wear civilian clothes when not in scrubs, you simply jut up your chin and stride in after a cleaning lady who opens the door with her key fob. You don't ask anyone for the break room since that would just prompt them to inquire about your identity. Thankfully, you've spent enough time in OR units to be able to tell where the staff foot traffic and conversation points towards areas where patients are not present. The break room is smallish, with two microwaves and old sofas and a desk with two laptop computers. A toilet in the corner of it flushes, and it's none other than Marsh who walks out. You met him only briefly, and you were very focused on Sherlock, then, but if there's one thing where your skills of observation have always served you well, it's in remembering faces.

"Hi," he says, sidestepping you to get to the tea kettle. He seems to assume initially that you're just a colleague, but then recognition dawns and he stops. "Um… are you authorised to be in here? I'm sorry, I can't really remember a name, but you were with the––"

"Mitral valve patient at the CCU, Holmes. I mean, I'm Doctor John Watson."

He offers his hand, confounded. "Yes, I remember. What can I do for you?"

"I believe they gave you a ring from the CCU. Patient wants a word. Needs a word."

"What's the matter?"

You need to convince your colleague that this is urgent. "I think there's a risk he may have been awake during the operation." This is at least a slight exaggeration, but it should get his attention.

Brows hitch up. You expect him to be, well, horrified at the prospect or at least dismissive, but his expression remains neutral. "Does he remember things?"

"I'm not sure. He isn't, either, but he's got memories disturbing enough that he refused GA for a cardioversion."

"He's got several big risk factors for accidental awareness, that's for sure. Hemodynamic instability, late night emergency case, cardiac surgery, neuromuscular blockade. Past substance use as well."

"Look, mate, I'm not saying the case was mismanaged and we're not looking to start any kind of a process, I just… he needs answers, and I can't give them to him," you explain apologetically.

"It's quite alright — we are aware that cardiac surgery carries a particular risk, and there's an in-house protocol for this sort of thing."

"Like I said, I'm not sure, and he's not sure, either, but…"

Marsh gives you a calm, confident smile. "I'll speak with him today. He's at the CCU? I know a colleague is free to take over my case since theirs got cancelled; I'll rearrange things at this end and come see him. I'll need to interview him twice if there is a significant suspicion that he was awake when he shouldn't have been. We can then arrange further support and counselling."

You doubt Sherlock would be amenable to that, because it sounds as though it would involve a psychiatrist or psychologist, and he's often voiced his disapproval of those fields. He seems to think anything that's not natural sciences is pseudoscience.

"Thank you," you tell Marsh, and mean it.

  
  


**Notes for the Chapter:**

> What Marsh says about risk factors for accidental awareness during general anaesthesia holds water. It does still happen, but very very rarely since we can now use EEG-based sleep depth monitoring, anaesthesia drugs and techniques have evolved, and muscle relaxants are not needed for all surgeries any more since we can use a laryngeal mask airway instead of intubation in many cases. But, for certain kinds of operations such as emergency c-sections and cardiac surgery, there is a risk that needs to be acknowledged and appropriate assessment and support provided for patients to whom it has happened. It should be reassuring that, while accidental awareness is very rare, even rarer is the worst subtype: being awake and feeling immense pain and fear during the experience. Many patients who believe they've been accidentally aware have actually had an operation under a nerve block + sedation, during which it's entirely normal to keep dozing off and then returning to even full awareness. Preventing patients getting the wrong idea and being alarmed afterwards requires meticulous explanations from the anaesthesia team beforehand on what is to be expected. When talking about sedation with patients, I never use the word 'sleep', for instance, to avoid that sort of confusion. There are also patients who falsely believe they've experienced accidental awareness even though their hazy memories are just from anaesthesia induction and/or being allowed to emerge once the surgery is over. More on accidental awareness later as Marsh comes to visit Sherlock.


	11. Repeat Customer

Back at the CCU, Sherlock has good news to share. He's sitting up in bed, and cocks his head towards the monitor the second you push aside the curtain. "Look."

"Sinus rhythm," you confirm with a grin. "It worked. Did you feel it?"

"It was subtle, but yes. Much more agreeable than being drugged and electrocuted."

It's your turn to execute your best eyeroll. "There's going to be a visitor."

"What? Why? Who? Mycroft promised to keep my parents away."

"The cardiac anaesthetist who gassed for your operation."

"Why the hell would I want to talk to him? I don't want to discuss any of it."

"No, I know you don't, but you should. You should tell him what you told me. He was there, and he can tell you which part of it was real, and what stuff is logical for you to remember and what might be…" you trail out, not wanting to feed into his anxiety.

" _John_. Spit it out."

"He'll screen you for accidental awareness during anaesthesia."

"I _knew_ it!"

"I said _screen_ , Sherlock!"

"Nothing's changed, then. Doesn't matter if I'm using or not, they still have no idea how to administer enough drugs to make sure I won't be vivisected."

That gives you pause. "It's not happened before, has it?"

"It was always the same. _Is_ always the same, at every bloody A&E unless they really get convinced there's something wrong and I'm not just _exhibiting drug-seeking behaviour_ ", Sherlock mocks in a falsetto voice. "Got a wrist fracture repositioned before any of the meds or even the local anaesthesia had kicked in because they were convinced that I was on, I quote, ' _so much sauce I wouldn't feel anything, anyway_ '. Had an operation for an abscess in my elbow operated on once. Afterwards, if I told them I was in pain, they gave me such small doses that they did nothing, and when I tried to tell them that, all I got was lectures about the ' _risks of large doses of short-acting opioids for recreational users_ '. Would I be surprised that they skimped on the anaesthesia drugs because they couldn't even find their arses with two hands? No, I wouldn't be."

"You done?" you ask gently. "I talked to Marsh and he wasn't, well, too aghast by the idea. They've got a protocol for suspected cases. You had risk factors for it, and not just the fact that you might have a high tolerance for opioids. Just speak with him, tell him all this. Just… maybe give him the benefit of the doubt instead of trying to make him pay for all those past things, hm?" You know that saying this won't erase years of mistreatment, but you feel compelled to remind Sherlock that this doctor hadn't been there on those prior occasions. There's so much to unpack here; maybe what he's gone through in the past few days have unearthed a few proverbial skeletons he never dealt with, never acknowledged, just numbed whatever he felt with more drugs.

Leigh, one of the CCU nurses, comes by to start an amiodarone infusion and to give a bolus dose of a beta blocker. "We're starting with low doses since your baseline resting heart rate after the operation was not very high. Do you go in for endurance sports?" she asks.

"Not really," Sherlock replies.

You have no idea how he could run the distance of half of London and not even get all that winded even though he never really exercises on purpose. Nature has gifted him with some very wonky genetics.

"Have you had your warfarin for today?" Leigh asks Sherlock. "Your INR results aren't in yet, and you're on twice a day enoxaparin until it's been above two and a half for at least two days."

"It was two point six yesterday," Sherlock tells her.

"It's good that you're keeping up with all that. Your GP will have to adjust the doses for you once you're discharged."

"I will be doing that myself. It's hardly rocket science," Sherlock scoffs.

Mycroft has already supplied the flat with a bedside INR analysis unit, which will allow you to check his levels at home and adjust the doses accordingly. The big challenge will not be the warfarin itself, but convincing Sherlock to create at least some consistent routines with his diet since what and how much a patient eats or doesn't eat will affect their K-vitamin dependent coagulation factor levels.

Leigh gives him a slightly suspicious look, but doesn't press the point further, because the curtain surrounding the bed shifts and Marsh appears.

"Mister Holmes," the short-and-dark-haired anaesthetist acknowledges. "I believe we have something to discuss. Would you like Doctor Watson to be present?"

"Yes," Sherlock replies without hesitation. "You'll listen to him, at least."

"It's John, please," you tell Marsh, hoping he won't be put off by Sherlock's instant dismissal.

Marsh doesn't react to the jibe — just goes to find a chair he can plant next to the bed. You remain standing by the foot of it.

"John here tells me you've been remembering things which seem to have happened in theatre. Did those memories appear right after the operation or later?"

"Later, obviously, since you lot kept me drugged for several days after. Without my consent, I might add."

"What's the last thing you remember before going to sleep in the OR?"

"I can't say, because I don't know at which stage in the proceedings each memory was created, or if they're hallucinations or dreams. There is no precise chronology to them."

"Do you remember us coming to escort you from your room at the CCU into theatre?"

"Yes, vaguely. I was given a tablet of something about half an hour before that. I assume it was a sedative?"

"Routinely given to all cardiac surgery patients since we often have to do some unpleasant cannulations while they're still awake, particularly if it's an emergency case such as yours. What you were given was a benzodiazepine — do you believe you have a tolerance for those?"

"Not particularly, but I react paradoxically to some of them."

"In the memories you believe are from the operating room, were you in pain or anxious?"

"I remember specific instances of negligible pain, nothing more, and it was in my neck and my arms, not… not the chest. I was… I wasn't very nervous, at least." Sherlock frowns. "I think I remember hearing you saying things, explaining things."

"We gave you some fentanyl and propofol before I installed an arterial line in your wrist and injected some local anaesthetic into your neck for putting in a central line. We did that under sedation, not general anaesthesia. It's entirely normal that you were aware of much of what was going on. You had an oxygen mask at first; do you remember the start of the general anaesthesia? There was another face mask, and you tried to pull your hand away because the propofol appeared to cause some pain."

"I remember that."

"Do you remember anything involving a lot more pain, the sound of suctioning or drilling?"

"No."

"What about wanting to move or speak, but couldn't?"

"No, not as such. I didn't _want_ to move, everything felt heavy."

"Do you think you remember something between going to sleep and waking up?"

"I felt like something was stuck in my throat, couldn't talk. Then, it was pulled out which felt horrid."

"That must have been when they extubated you at the ITU. You were meant to be awake or very lightly sedated when that happened. It's entirely normal to remember something of it."

You appreciate Marsh's conscientious manner of explaining things, of emphasizing what is normal and not inadvertent wakefulness. Sherlock is answering him with less irritation and anger and looks to be really listening to the answers.

"Did you dream during your surgery?" Marsh asks next.

"There's a dream that keeps repeating, now: I can't recall if I had it then, or just after."

He repeats what he'd told you about watching the operation from somewhere else in the room, of seeing his heart placed on what sounds like the Mayo table which is a type of instrument table. He mentions seeing you in theatre.

"Doctor Watson was not present, and since what you just described is not an accurate account of how a valve repair is done, I can tell you with all confidence that it's a dream," Marsh says. "Have these dreams you've been having felt upsetting or disturbing?"

"Not the ones which I can tell must be just dreams. I just can't construct the sequence of events in my head. There's a lot of lost time. That's… disconcerting."

"He reconstructs events for a living. Solves crimes. He doesn't like holes in stories," you explain to Marsh. You wonder how much lost time there is in those years when he wasn't solving crimes but trying to lose himself, instead.

"What else was I given besides that questionable benzo?" Sherlock asks Marsh.

"We used propofol and ketamine for the anaesthesia induction; in your case, the dose needed of propofol might be elevated thanks to your history, but the heavy dose of ketamine which we started with should ensure that you weren't awake when we intubated. Soon after, we swapped to sevoflurane, to which past opioid or even benzodiazepine use has little effect in terms of required doses. We used bispectral index monitoring during the operation to gauge a suitable depth of anaesthesia, but it often lags behind in demonstrating when the patient has fallen into deep sleep. To the best of my knowledge, as far as I could estimate, you were deep under when we intubated and began the operation. I checked the printouts, and at the time the first incision was made, your BIS level was thirty, which is a level of deep surgical anaesthesia. The effects of the ketamine bolus dose tends to linger a bit and elevate the reading; sometimes that makes us slightly overdose the sevoflurane to be on the safe side. What I mean is that if the level was thirty, your actual level might have been even deeper than that when taking the ketamine into consideration."

"Why? Does the index not measure NMDA receptor suppression?"

Marsh's brows hitch up. "I wasn't aware you were medical."

"He's not," you say. "He is a graduate chemist and knows a hell of a lot about pharmacology. And not just recreationally."

Sherlock gives you an unimpressed but not exactly angry glance. Both of you know that he probably knows more about central nervous system pharmacology than you — and you're the bloody doctor here.

"Ketamine creates a dissociative anaesthesia — the brain is essentially awake, but its ability to register the surrounding world is cut off," Marsh explains.

"You said something about––" you start.

Sherlock is already there. "I remember being awake, but I couldn't hear or see or feel anything."

"And then?" Marsh prompts.

"Then… nothing."

"The records show no malfunctions of dosing equipment, nothing out of the ordinary in how the operation itself went. As I told John, emergency cardiac surgery out of office hours on an unstable patient does carry a risk of accidental awareness higher than in most other operations, but I haven't heard anything that would warrant a significant suspicion that it happened, and many things in the anaesthesia records speak against the possibility."

Sherlock breathes out through his nose, and his expression shifts from warily curious to angry and disappointed. "You just want to avoid litigation."

"No, that's not it, Mister Holmes. I don't want to fail in what is my most important task during an operation done under general anaesthesia, which is to make sure the patient is asleep throughout. If that happens, I want to know about it so that I can make sure it never happens again. It's a recognised risk, which can be if not eliminated then at least managed."

"But essentially, you think I'm just being histrionic."

"No. The opposite. Memory formation during anaesthesia and sedation is a complex and not an entirely understood process. There are several kinds of memory, even; there's explicit recall which means––"

"––conscious recollection of events," Sherlock finishes impatiently.

"And there is implicit recall, which are things we experienced but cannot recall directly, but which affect our behaviour afterwards," Marsh concludes.

This makes you think about Sherlock's lost years again, of things which may have happened in hospitals, then, bad things which he doesn't remember in any detail because he'd been under the influence. Despite lacking explicit recall, those events seems to have imprinted themselves into his limbic system, causing so much fear and distrust that his emotional resilience is compromised whenever a crisis involves a threat to his physical well-being. And now, he's reeling from a near-death experience during which his heart had to be stopped.

"It applies to intensive care and critical illness in general that when you go through something which leaves you with fragmented, scary memories, and everything happens so quickly that you can't really even adjust to the idea of being ill — let alone needing urgent surgery — it takes time to process all of it, and you're processing it even when you're not consciously thinking about it."

"Dreams," Sherlock concludes resignedly.

"Sedation at the ITU always creates very broken recall, distorted memories and difficulties in being able to recall a timeline. Your notes say that your behaviour in intensive care varied between rational and amnestic and delirious. Things that happen when you're confused from being ill and sedated are not often remembered very accurately."

"So I just have to accept the chaotic recollections and move on? Stiff up the lip?" Sherlock asks venomously.

"The opposite, really. Talk about it. It might not ever make complete sense, but ruminating on that stuff alone is just going to make you feel, well, more alone. There are peer support groups for cardiac surgery patients, counselling services––"

"Over my dead body."

"And you've got someone here you can talk to; you can thank John here for raising the issue. I will be happy to follow up with you later, perhaps in two to three weeks or so, to see how you are doing."

"I'm sure there is already an exhausting list of follow-up appointments scheduled," Sherlock dismisses. "Not necessary."

Marsh rises to his feet and steps back, then leans his palms on the back of his chair. "I'm going to be frank. You've been through the medical equivalent of hell, Mister Holmes. Anyone would be rattled by the experience. It doesn't make you hysterical, weak or exceptional in any way that you'd be affected. There is a significant, recorded incidence of PTSD after emergency surgery and critical illness."

"I do not have _PTSD_ ," Sherlock scoffs. "That's preposterous."

Why does he always have to be like this — pretend that the normal rules and limitations of the human body and mind don't apply to him? You want to shake him, but you know it wouldn't help. He remains the most stubborn man in England whose intellect and consequent ability to over-rationalise things is oftentimes his own worst enemy.

"I wasn't saying you have it, just illustrating what a life-altering event this is, and how normal it is to need time to adjust to it," Marsh explains.

"The valve has been repaired. Hardly life-altering," Sherlock dismisses, crossing his arms.

"Anything else you'd like my take on regarding whether it could be something that happened during the operation?" Marsh asks. Though no longer sitting down, he doesn't sound rushed or as if he's trying to conclude the conversation, just curious.

"I don't know. Probably not."

"How are you getting on, then? Usually, patients don't stay at the CCU for this long."

Sherlock shrugs. "Repeat customer, not a long-term admission. They wouldn't do a rhythm reversal from FA at the ward."

He's not looking at Marsh anymore, and seems to have lost all interested in the conversation.

"I see."

"Was that enough?" you ask Sherlock, "I mean, did you get your questions answered?"

He doesn't answer.

"I must admit reading your blog, John," Marsh says, "the name Sherlock Holmes is quite unusual, so I couldn't help googling it."

Sherlock uses the remote the lower the head of the bed and carefully turns to his side, facing away from you and Marsh. Clearly, the conversation is over.

You and Marsh step out to the nurses' station, and you thank him for his time.

"I'm pretty confident he wasn't awake during the operation. We did what we could to minimise the risk. I think what he remembers was from the preparations and from the ITU."

"Yeah," you agree. That's the answer you were hoping for. Whether Sherlock believes the man entirely is another thing. You fear that he might still think people are ignoring and dismissing his concerns because of his past drug history. You don't, and you really hope he knows that.

"Have a good holiday," you tell the anaesthetist, who excuses himself.

You head down to the cafeteria for some lunch. When you return to the ward, Leigh tells you in hushed tones that there had been an argument between the ward registrar and Sherlock over how long he is supposed to remain at the CCU since the amiodarone, the beta blocker and the vernakalant require extended post-cardioversion monitoring particularly in his case. Sherlock had been adamant he should be sent right back to the regular ward.

"He eventually relented when I told him it's not just the registrar's opinion — that it's pretty standard for postoperative patients to remain here for a few days if there are complications. I think that was the wrong word to use," Leigh sighs.

"Believe me, half the Cambridge Dictionary would be the wrong words right now," you console her.

  
  



	12. Long-Term Plans

The atrial fibrillation stays away, though you'd never believe it if you just looked at the way Sherlock is behaving. He's constantly on high alert, avoiding sudden movements, refusing PT and mostly just staring at the ceiling or occasionally reading something on his laptop. He doesn't seem to want you to see what. You're convinced he's terror-googling things, but you can hardly tell a grown man what to do, can you?

You can't confiscate his laptop. Well, you _could_ , but… you're kind of hoping Mycroft would do it for you. You can't turn off Sherlock's brain, and you can't promise the arrhythmia won't come back, because it could, and he probably fears flip-flopping back and forth between the CCU and this ward forever like an Alice stuck looping in some hell dimension version of Wonderland. He seems to be trying to stay as quiet, as immobile as possible, so that time would just pass and allow him to be discharged. What happens after that is anyone's guess. Things would have to get pretty dire again for him to be willing to re-enter this place, of that you're convinced.

You keep playing that argument you had with him in your head, the one about whether he's a patient or not. It appears he's finally embraced that role, but this isn't what you wanted. You wanted cooperation; you wanted realistic thinking, and you wanted optimism. Does that sound like Sherlock, ever?

He could be pretty self-sufficient by now, with the help of the PT he's chased out three times, now, with his sharp tongue. He could manage most of his clothes, walking around the ward, even going down to the cafeteria with an IV pole, but he won't. He's done a 180 from ignoring his Transport and thinking it's indestructible to acting as though just breathing deeply might break it. You no longer have to fear him overdoing it, but as it happens, there is such a thing as _under-_ doing it. Trust Sherlock never do anything by halves — or just elect to do nothing at all when things don't go his way.

Last night, on the phone as you walked from the Tube station to the flat, you complained to Mycroft that Sherlock is acting as though a bus has left him on the wrong stop.

"While before, he believed he could outrun it," his brother concludes dryly. "How observant of you."

This isn't praise. He thinks you've finally spotted the blindingly obvious.

"What should we do, then? How do we––"

"We give him time," Mycroft said sternly. "You cannot force these things with him."

Right now, you'd gladly go back to being a punching bag if it meant Sherlock was fighting to get back to his life.

"It's definitely sunk in," you confirm to the older Holmes "What's happened to him. The arrhythmia burst the bubble that nothing's going to be different in the future, that there can't be complications or that he doesn't have to be mindful of the new valve."

"This phase was always going to come," Mycroft tells you and sounds much less worried than you. His perspective of Sherlock's psyche is longer, and you find his calmness marginally reassuring. "How long it lasts is anyone's guess."

_____________

A Friday morning round at the ward ends up adding insult to injury. A cardiology consultant who is not Mike and Sherlock's surgeon come see how he's getting on. Since the surgeon's visits are no longer daily, he has decided to make use of today's joint bedside conference with the cardiologist as an opportunity to gang up on their recalcitrant patient to lecture him about lifestyle choices.

The smoking will have to go, they tell Sherlock. You think it likely that this will become a war once you're back at home — a last stand for independence and free will.

They tell him he needs to avoid salt and to keep his intake of leafy greens steady. Sherlock enjoys any food that's well prepared and inoffensive enough in consistency for his delicate palate, but you sure as hell know he won't bother reading any package inserts to make sure his breakfast cereal or takeaway doesn't contain too much sodium chloride or vitamin K.

Then, when you're already tempted to step in because you know it's all a waste of breath that's just going to make Sherlock cranky at you for the rest of the day, your colleagues move on to the topic of drugs. Recreational ones. It's in Sherlock's records that he used cocaine, and he now gets a stern warning not to indulge in stimulants if doesn't want to get another bout of atrial fibrillation or stress his heart with unnecessary sinus tachycardia.

"I have not used in two years," Sherlock tells them. "Not that you think anything that a single word that comes out a junkie's mouth is honest."

"That is not what we were inferring at all," the cardiologist, a fifty-something woman who never smiles and to whom you have taken a quick dislike, says.

"I have told at least a dozen doctors in this bloody hospital the same, that I no longer use. Yet I get lectured today as though I'd just snuck to the loo to shoot up."

"Some relapse risk always remains," the cardiologist tells him in a superior tone. "We are just making sure you're well-informed about your choices."

The surgeon clears his throat. "Um, on that note, we might have a word about exercise habits––"

Sherlock grabs a handful of the ECG wires a lab technician has just attached to his chest for his daily film and rips them out theatrically, half the electrodes peeling off his chest and half of the wires just separating at the snaps. He then drops the entire pile onto the floor. "Self-discharge forms. _Now_."

"Out, please," you tell the two other doctors. Your low, quiet tone is pointless, of course, since Sherlock can of course hear it. "Not the right time."

They glance at each other. "We'll revisit this topic on a better day," the surgeon finally says. It sounds a bit like a warning. "I hear physical therapy isn't going well?" he prompts.

Sherlock averts his gaze, says nothing.

That silence continues well into the evening.

____________

It's Wednesday. Two weeks have passed since Sherlock couldn't chase a suspect. It's been thirteen days since his operation. You can't decide if other visitors than Mycroft would be a good or a terrible idea, and you can't decide if the decision should even be yours. Two days ago, when you'd gone for the afternoon, you'd returned to a disgruntled Sherlock who announced that Molly had, quote 'popped by without invitation', and that she 'did not stay long'. You have a hunch whatever kind of dreadful reception she'd received had affected that decision.

Sherlock's parents can hardly be delayed any longer, and he endures their attention for forty-five minutes in the afternoon with nary a word. Mycroft is with them, explaining things and keeping a conversation going.

You feel apprehensive in the company of so many Holmeses. Like Mycroft, their parents seem to accept and encourage your presence, but you can't help wondering what it is they see when they look at you with their son. A friend? A colleague? Something else? All of these things? Perhaps, since Sherlock has always defied explanations and categorisation, they assume his relationships would be the same — difficult to define. You can accept that, because you've become painfully aware that it's you who needs these labels and explanations, not him. It's your identity being dangled off a cliff every time you own up to your attraction, not his.

You're drawn to him in a way you haven't really felt for another human. You know lust well; you know habitual attachment between two people dating each other but not in love; you know parental love, love between siblings, you know what it's like to have a mad pash for someone you don't even know very well yet that passes, leaving behind a disappointingly weak emotional hangover.

What you feel for Sherlock, you haven't known with the people you've pretended to date. It's consuming, yet so natural somehow. He's not even _yours_ , but he still leaves no room for anyone else besides the two of you. You've committed yourself to someone without even realising — you, who's always felt the compulsion to run when you felt you were being ensnared into something by a partner who clearly feels more for you than you for them. Is it because you know he senses it, too? With Sherlock, there's no way to be certain. He may not read people well or at all, but he's taken off his armour for you, relied on you, bared his soul for you, sought your attention and your affection and you've seen him, _really_ seen him, and welcomed him. How could he not _see_ you, too?

What you feel for Sherlock makes you a more patient man than you’ve ever been. You don’t want to rush; wherever he is, you are content to be close.

He keeps glancing at you as he endures his mother's fussing and his father's inquiries into his well-being. You can't read in his eyes what it is he wants or expects; mostly he seems to just want affirmation that you're still there. All you can respond is a nod as you stand in near parade-rest by the door.

The Holmeses leave behind treats Sherlock doesn't even look at. He doesn't want his laptop when Mycroft asks. He puts his headphones on but doesn't even listen to music. When it's just you in the room with him, he is mostly lost in thought. Ignores you, which is odd, considering that when others are present, he keeps track of you. The aggravated energy he radiates normally continues to be replaced with something subdued, grey and stagnant.

You tell Lestrade when he texts that it's fine to pop by; you hope that a bit of shop talk would rouse Sherlock out of his reverie. You fuss a bit before the DI shows up, offer Sherlock his own dressing gown delivered from home by Mycroft since appearances seem to matter still and he hates the fabrics and the colours of the hospital clothes. You ask if he wants help with his hair, and the inquiry doesn't even receive a reply. He just… exists, and you feel increasingly embarrassed to be buzzing about him like some fly trying to find its way back outside.

While waiting for Greg to show up, you stand by the window, hands clenched into fists, repeating to yourself what Mycroft had confirmed — that it'll take time, that this is a phase that was expected. You tell yourself that this is what you should have been hoping for, that Sherlock can't process what's happened until the reality of it hits him.

You just didn't want it to hit quite so hard.

Sherlock is lying his side, facing away from you. You lower the bedrail on the side of the window, sit down on the edge so close that your side is pressed up against his blanket-covered bottom.

Normally, you wouldn't do what you're about to do. Normally, there is that thin, elusive film of proper and decent and straight and he's-just-a-mate between you but right now, you feel just like you felt in Afghanistan when your fellow soldiers went down: that injury and illness make those boundaries feel as though they never existed. As a human, as a doctor, as a friend and as someone who cares about Sherlock more than you often care about yourself, the sight of him screams out to you for comfort, for connection, for something that could convince him better than words that he's not alone.

You lean closer, drape your arm around him and pull him closer to you, exhale and then release. He's listless, curled into himself as you gather him against you like a bag of bones. He lets you. You give his shoulder a squeeze, rest your palm on his shoulder blade. He's warm, the angles of the bone sharply pronounced under your fingers. He needs more food. He needs more sleep. He needs… more than he ever grants his body because he looks down on it, thinks it inferior to his intelligence — a nuisance that has now betrayed him and overtaken everything else in his life.

"Greg will be here in a minute," you tell him quietly.

No answer.

"He promised cold case files."

"I can't work like this," Sherlock mutters.

"It's just files, Sherlock, not field work. Just something to pass the time. Get your mind off the rest of it."

"You think the victims of the acts in those files would agree that it's just the equivalent of crochet?"

Thank God for that snark. You'd take that anytime over heavy silence. "I can tell Greg you're not up for it today, but you have to decide soon."

"Do whatever you want," he tells you and says nothing more until there's a knock on the door.

You hastily leave the bed and raise the rail back up out of habit; Sherlock is coherent and not about to fall off the bed anytime soon, even if he took a nap. It's just what was banged into your brain during training: never transport a patient without the rail up. Sherlock doesn't protest, so you leave it like that.

Greg has had the sense to bring in some decent coffee from a Costa, just the way he knows Sherlock likes it. This bribes Sherlock into raising the head of the bed, turning to face the room and listening to the conversation even if he contributes little.

"Must drive you barmy, being stuck here," the DI says. As a police officer, he's used to suffocating silences in uncomfortable situations, is adept at diffusing tension with a bit of humour. Thank fuck for that. "Room service any good? At least you've got a butler," he jokes, cocking his head at you.

"Not that different from home," you laugh with an eyeroll.

Sherlock speaks up suddenly: "That's an insult to John's vital contributions to the Work."

Perhaps he'd been so distracted that he didn't pick up on Greg's sarcastic humour. Then again, he rarely does. You've suspected for long that he has learned how to deduce when people are making fun of him, even if he can't decipher the specific underlying subtext. You're pretty sure he's learned to recognise those things because he's been subjected to bullying so many times. It's in the way he goes for offense instead of defence when interacting with people he knows don't like him; it was plain as day in his interactions with Sebastian Wilkes. That first night, he tore into Sally Donovan and Anderson in a very cruel manner before they got any punches in. It seemed like a particularly intense knee-jerk reaction to being embarrassed in front of you, a new person he seemed to want to impress. A person who he wanted to like him. Having to work so hard — to overdo it, even, with that wink and exaggerated politeness he never employed later — spoke of someone who values a friendly approach from others so very greatly because it's a precious thing rarely experienced.

He has friends but doesn't even realise it. He seems so sceptical that anyone would want to be that for him.

"What was it, then, exactly? What did they fix?" Greg asks, and you realise you never explained to him Sherlock's condition. He'd just texted a few times, asking how Sherlock was doing and whether he could visit, and you just gave the name of the hospital and a time.

"Sherlock?" you prompt. "Want to take this one?"

"You're the doctor," he says tiredly, and wraps both hands around his Costa cup.

"He had some damage to his heart from an infection years ago. It weakened the tendons connecting his mitral valve to his left ventricle. Those snapped, and he…" you decide to forgo explaining how close to death he'd been, "…the valve had to be replaced. There's a mechanical one in, now. You can hear it when it's quiet."

"And it works? I mean, it's as good as your own?"

"It still needs to grow into the tissues properly and that takes time, but yeah, it should allow for normal life."

"Normal for who?" Sherlock mutters.

"You gotta be on some meds, though, I assume?" Lestrade asks. "Long-term?"

"Anticoagulant," Sherlock says. "Possibly some others, if I deem them necessary."

He's hardly the one to make those assessments, but you bite your tongue because he needs this. He needs that shred of control because you know he lost pieces of it when he had to tell you about his dreams and even more when he went into A-fib. The story he'd told himself of a swift, uneventful bounce back to his old life has been edited with heavy, red ink. He needs to write himself a new one, a more realistic one, but he's just staring at those red markings, now, wondering why he should bother.

"Best avoid getting shot or stabbed on cases, then, if you're on a blood thinner," Greg says cheerily, and you grin.

It's a welcome reminder that once he's better, Sherlock _will_ be allowed back in, and even with an engineer-constructed metal valve in his heart, he can go back to what he loves.

If only he stopped acting as though the world has ended.

  
  



	13. Back Home

You wish you could say that Sherlock is back home safely. Objectively, that's true, but he's not acting like it.

The day he's discharged, he can't settle anywhere; he follows you around to the point of exhaustion, touching items but not picking them up, getting food from the fridge and not eating it. He's aimless, haunted, and you can't come up with a single damned thing you could do or say to help save from yelling at him to sit down. It won't help, so you let him wander. Recovering from getting helped up the stairs had momentarily wrung him dry, so he'd accepted a lie-down and a cup of tea initially, but by the time the sun sets on the day of his discharge, you start to feel like you're watching a newly captured zoo animal.

When you watch the evening news and a story about the NHS comes on, he grabs the remote and shuts off the telly. Maybe it was the images of a hospital ward on screen.

He can't play the violin because he can't keep his arms raised yet because of the pain and how it stretches his incision, but he picks it up periodically, runs his fingers down the strings or plucks them, then puts it back. Eventually he puts on the fancy wireless headphones Mycroft had gifted him and continues wearing a trench into the carpet.

You're tempted to give him something; you still have some sleeping pills you got prescribed after being invalided home. After moving in with him, you never needed them.

Maybe they're expired. It's not a good idea, anyway. It's not going to fix anything to drug him. _Maybe they could be slipped into his tea_ , you think idly when feeling particularly empathetically pained by his pacing, then want to kick yourself for sounding so much like Mycroft. You wouldn't betray Sherlock's trust like that, not even with the intent of helping him. You're not his doctor, you're his… friend.

He acts oddly detached when you remind him to take his meds. He looks like he's zoned out, slipped into his Mind Palace with just a basic level of functioning remaining so that he remembers to continue breathing and won't walk into walls. He sits by the kitchen table opposite you as you're having dinner he declined. It's quiet; there's little traffic outside since it's quite late and fenced-off roadworks have diverted some of it to the nearest streets. All you can hear is a clock ticking.

You're startled to realise that you've not heard it before. A confusing moment passes before you realise it's Sherlock's replacement valve. It _would_ be disconcerting to lie in bed trying to catch the tail end of sleep and listen to _that_ , wouldn't it?

Shouldn't it be a reassuring sign that it's working? Maybe it's not, if the person whose chest it's buried in fears that a moment might come when it stops.

You clear your throat. "You think you'll get used to it? The sound?"

Sherlock blinks back into a fuller connection with reality. "What sound?"

"The valve."

"I think I maybe have, already."

"Well, that's… that's good," you suggest. You struggle to decide whether you should reveal to him that Mycroft is sending a PT round tomorrow. It had been recommended by the hospital that he should continue such rehab once discharged, but of course he's not going to lift a finger to find a therapist and get the whole thing going.

You hope the new PT is made of sterner stuff than the hospital one.

"We could order in tomorrow," you suggest, "can't rely on Hudders' cooking for too long. I'm sure she's got better things to do than to run a catering service for us." You omit mentioning how you might want to avoid some of your regular delivery places now that Sherlock shouldn't be having too much salt. Good food is something he seems to derive joy from when not stressed out. You don't want to take that away from him because he's had so much in his life upended lately.

"Perhaps," he says absently. "She said she'd bring a heat pack for my shoulders."

It sounds like it's something he welcomes. "Sore?"

"It appears that cracking open a ribcage affects the physiology of the entire torso. I have not fully appreciated the importance of the sternum before."

You decipher that as a yes. "We could fill you a hot water bottle for bed."

He doesn't reply. You're relieved that he's willing to engage in even just this meagre amount of talk about his condition. It's always like walking on eggshells before he snaps and shuts down the conversation.

It's quiet again; only the scrape of your knife against the plate gets his attention in the next few minutes — you can see the cringe when his sensitive ears pick up on the screech.

"Must you?" he chastises. "It's enough that I think I keep hearing the––" he suddenly catches himself and snaps shut his jaw.

You put the cutlery away, the gravitas of the moment dragging on your shoulders. You feel the way he looks on a good case after having caught wind of a clue, and you try to conceal any reaction your face might be betraying. "The valve? You just said––"

"I keep thinking I'm hearing all the monitors."

"You had to listen to them for over a week." You notice he's sweaty, though it's quite chilly. "Sherlock? You alright?"

"I can't shake it," he curses from between clenched teeth, "can't shake the feeling that something's about to happen."

"Something bad?"

He gives you a scathing glance, which tells you you're an idiot for stating the obvious. You're tempted to joke, desperate to lighten the mood because you're rubbish at conversations like this, you're terrible at discussing the feelings of anyone, most of all your own, but you know he'll bite your head off if you attempt humour right now. Maybe it feels like someone is making light of his worries, and if he's felt ignored and belittled by people before when he's been ill… _Tread carefully_ , you tell yourself. The raw anger in him now has reared its head many times during his hospitalisation when he's been particularly frustrated about his infirmity.

"Did you take photographs?" he suddenly asks.

"Of what?"

"Me. At the hospital. At the ITU."

"Why?" You know you're trying to evade, because you have no idea why he'd have this idea now, and if there is anything good that might come out of this conversation.

"I want to see. Give me your phone."

"I didn't take any."

He slips out his own phone from his dressing gown pocket. "Mycroft must have some."

"But _why_ , Sherlock?" you plead. "Why would you want to see that?"

You shouldn't have asked, because he climbs to his feet, eyes blazing with rage. "And you wouldn't? You'd just content yourself with all the lost time, all the not knowing, with everything you weren't told and don't understand?"

"There _is_ a lot I don't know and didn't see about getting shot and right after," you tell him, grabbing the edge of his sleeve and then prying the phone out of his hands. "Because I just wanted to forget about it and move on."

"I can't!" he complains, "because I have to listen to that thing ticking away like a IED."

You could tell him the IEDs you saw in Kandahar never emitted any kind of ticking, but he wouldn't want to be corrected, now. Why had he told you he got used to the sound? Why had he lied? You're getting whiplash from his mood swings, from his constant denial-flirting-with-crisis way of dealing with what's happened.

He slumps back into the chair, running an idle palm across his chest. Underneath the T-shirt, a dressing is covering the wound. "I thought coming home would make things… different. Normal."

"New normal, I guess."

"I don't know what that means."

"Getting on with rehab. Going back to work. Building your strength."

"Can't sleep or concentrate. Much use I'll be for the Met."

"I didn't mean going to work right now. When you're ready."

"Which is _when_? How do I know?"

"You don't have to. That's what your follow-up appointments are for." You hope to hell that he'll actually attend them this time around. "That's what I'm here for," you add.

His face falls before you realise what you've said. "And then what?" he demands. "I get _better_ , and you can quit your charity project?"

"No," you say firmly. "Not what I meant. I meant I'm here for you. Whatever you need."

"I don't _need_ anything except for everyone to stop fussing."

He needs a lot of things, and one of them is a lot of help with everyday stuff until he can lift his arms properly. He also needs someone to be the soft wall he can bang his head against safely.

  
  
—————————

You manage to convince him to let you remove his stitches and staples the next morning. You doubt he's slept any — he looks like death warmed over. He insists on sitting by the kitchen tableinstead of lying on the sofa. You have not forgot his reaction to seeing his incision for the first time, and how nauseous he got when the drains were removed, but he'll not be swayed.

The wound has healed nicely, and its formerly puckered edges have smoothed down a bit. The scar will be very noticeable for the rest of his life, but it'll fade into a neat line in the middle. He closes his eyes briefly when you wipe his chest down with a cloth dipped in warm water to get rid of flecks of dried blood. His eyelids are heavy, his breathing deep, and his balance on the chair dips a bit to the side. You clasp his shoulder to keep him steady.

His eyes drift open. "What?" he asks tiredly.

You put the cloth in the salad bowl you'd filled with water and cover the incision again. Then, you stand up and extend your hand. "Come on."

"Why? Where?"

You pull him gently up as he takes your hand, and he follows you wordlessly to his bedroom. You quickly tidy the bedding by spreading the duvet across the entire bed. "I'll keep you company," you suggest quietly and sit down on the bed, patting the middle in invitation.

He circles to the opposite side and painstakingly, side-first with his arm muscles bearing the brunt of the work, lowers himself onto his side. You turn on the lamp on the bedside cabinet on the opposite side and grab whatever book is at the top of the one of the piles on the floor. It's on the history of London, and it'll have to do.

He's facing away from you, topmost shoulder hunched forward and dressing gown cascading down his hips and bottom. He'd insisted on putting it back on when you made him remove his T-shirt for the stitch and staple removal.

You focus on your book, letting him rest. After some twenty pages, the mattress shifts and he slowly turns to his back, then on his left side facing you. You give him a smile, then readjust the book in your hands.

He shifts closer and finally his cheek is resting on your good shoulder. You can hear his valve again now that he's so close and firmly decide to try to consider it a reassuring sound, even if you can understand how he feels like it.

It doesn't feel odd at all, not after everything that's happened in the past two weeks, to be resting quietly and so close like this. _It's Sherlock_ , you tell yourself. _Forget about what other people think_.

His eyes are closed. "I can hear yours," he mutters quietly. "And I think you're having some extra beats."

They're his fault, but you don't tell him this. You welcome them, because they're brought on by relief and his welcome and exhilarating proximity. At least they're less alarming to the cause than an erection would be.

  
_____________

A week passes, and he doesn't start sleeping at night. You tell yourself it's because intensive care messes up a person's sleep cycles, and that being confined mostly to bed at home will make it worse. Especially for someone like him who's never stuck to any sort of regularity with their rest. You tell him that over a breakfast he barely touches.

He's quiet and subdued, except for when he's kicked to the kerb six PT candidates sent by Mycroft. His movements were inordinately careful for a few days after the removal of the stitches — he seemed to fear the wound would rip open. He should be desperate for a case, cranky and acting out. He doesn't even sulk, just looks as though he keeps forgetting about himself.

He's thin. It seems as though his pyjama bottoms ride lower on his hips every day.

He's not getting better. Not in a way you are certain he expects to be. And you don't know how to fix it. Avoiding this sense of helplessness is what made you pick your specialty — that you could mend broken bones, sew up bleeding vessels, repair torn tendons. Nobody told you how to repair a broken spirit. Not like his. Because he's like no one you've ever met and since you saw him you've been unable to look away.

And that's why you're not even angry when you learn the reason why he acts so weird on a Wednesday evening. His eyes are bloodshot, he's dizzy and slow, he talks very little and what comes out is a bit slurred. What really clues you in that something is wrong that he devours the bag of old, stale chips which has been sitting in a kitchen cabinet for at least a year. It's even a flavour he's declared he hates.

Turns out he's stolen Mrs Hudson's stash of herbal soothers. You've always had a hunch of what they really are, but it's none of your business. Sherlock has used some of his chemistry equipment to extract the good stuff out in concentrated form.

You take his pulse; it's over a hundred. "You've overdone it," you say tiredly. "How much did you take?"

"Can't be sure what the original concentration was," he dismisses with a floppy hand where he’s sprawled on the sofa.

"Care to explain why, then?"

"Can't smoke. Can't work. Have to do _something_."

You hitch your brows skyward, pursing your lips. "And you thought cannabis would be a fun new hobby? Was it something you did before?"

"Very few times. Tedious. Too mild."

"Right now, it's plenty enough for your heart to handle."

"My heart," he starts to declare slowly, "got through being stopped. This is nothing, John." His tone is completely off, he's the opposite of his own clever self, and you decide you hate seeing him like this: reduced and confused.

Before you manage to decide whether to lecture him more or just say fuck it, Mrs Hudson comes calling to inquire where her soothers have disappeared.

"I know precisely where they are right now," you tell her, crossing your arms.

"Where?" she asks, genuinely perplexed.

"In his circulation." You nod towards Sherlock, who seems to have nodded off.

"All he needed to do was ask," she tuts. "I've never said no before."

"He does this? I mean, he's asked before?"

"Very rarely. Not since you've moved in."

You don't want to start defusing that statement. "He'll pay you back, I'm sure."

"Of course, he will. Is he alright, John?"

"Not really. He's recovering, but…" You sigh, watching how his breathing deepens. His position looks uncomfortable; he'll have a crick in his neck in the morning. You need to wake him up and get him to bed.

"He has his own way of dealing with things," Mrs Hudson says.

"Taking drugs and not talking about them?" you suggest.

"Have you considered he took them as a way to tell you things?" she asks.

How is it that she has such a talent for seeing through Sherlock so easily when you so often reach only the surface level?

"To tell me what?"

Mrs Hudson's lips purse together. "You haven't seen him when he uses, have you?"

"Thank God I haven't, no."

She's looking at the floor. "There are probably many reasons, but he once told me that it's either when he needs his thinking enhanced, or when he can't deal with his head because he fears it'll keep betraying him."

"It could be both, this time," you admit. Sherlock has complained about concentration problems, about his head feeling foggy — which is probably because he's so sleep-deprived. But he wouldn't pick cannabis as an _enhancer_ , would he? It dulls and mellows, doesn't sharpen.

' _He fears it'll keep betraying him_ ' are the words that keep echoing in your head as you watch Mrs Hudson leave. If you had to describe Sherlock's behaviour in the past weeks, fear would be at the top of the list. There's the fear that he could get sick again, but is that all?  
  
  
  



	14. Counting Our Losses

"I'm for bed," you say the next evening.

You're hesitant to leave Sherlock alone with the cooling embers of the fire you had going earlier, but since he barely acknowledges your existence these days, it's a guilt-ridden relief to be alone in your bedroom every night.

He hums absent-mindedly, pushes the remote control on the coffee table aimlessly towards a cup of tea of which he'd drank only half. His arms are in goosebumps, his feet bare. The sitting room is draughty, and you can't leave him like this.

Without asking for permission, you enter his bedroom — just like you have bulldozed, out of necessity, into every bit of his privacy after he's come back home. It's fine that he needs your help, but you wish more than anything that he rebelled against it again. More than once, you lectured him at the hospital about being mindful that he's a patient, and now you want to draw blood from your tongue for all that because this is precisely what he's doing, now, and not even just to spite you.

You pick up his duvet, noting with gratitude the fresh sheets which are Mrs Hudson's doing. They do little to banish the sense of malaise and stagnation which lingers like a fog in the flat, but these days you notice even the small things that cut through the emotional ague. You bring the duvet up to your nose, inhale the scent that is a marriage of dust and lavender and detergent and Sherlock.

You take the duvet to him, wordlessly drape it around his shoulders. He leans back against the sofa, closes his eyes.

You should call the locum agency, pick up some shifts. Then again, you know what walking the last steps to the front door after would feel like, how the rock at the bottom of your stomach would grind and make the bile churn. He's anxious about everything and you're anxious for him. What a pair you make.

"I could get you something. Help you sleep. Just for a few days. It's hard to get a sleeping rhythm back after a while," you tell him.

Maybe you should go sit in your chair. Maybe you should go to bed, after all — give him the space he hasn't actively sought but which you feel between the two of you like an open wound.

 _No_ , you decide. He's not going to talk to you on his own, and you've grown too furiously worried to be afraid of his reactions any longer.

"Took me ages to get even a few hours' sleep after I got sent home," you say.

Maybe if you offer a memory personal enough, he'll let you in. Believe you. Believe that you can help.

He looks like an unanswered question. An unfinished task. Hag-ridden, like he's always been as a person, somehow. It's just that whatever troubles him these days has swallowed him whole instead of just being something on the surface of which he treads water on the best of days and sinks under on the worst.

You have to do something. Say something. Pulls your boots out of the bog because both of you can't be sinking like this. It's been four days after he got high on Mrs Hudson's stash. Would he resort to something stronger, eventually? You don't know if he keeps forgetting his meds or genuinely tries to avoid taking them.

"Just… just say it?" You prompt him gently. "Whatever it is. Even if it's complicated or a mess or you don't even know what's keeping you from… from everything. It's been weeks; your valve is doing alright, you're doing alright. No reason why we can't be getting back to normal."

He snorts, and it nearly startles you because it's the most intense reactions you've managed to loosen out of him lately.

"No reason, John? Really?" he asks; the mockery in his voice is hollow and wan like his complexion, but the snarkiness is a good sign. Maybe he's ready for this conversation. Maybe. "As usual, everything important has escaped your notice."

 _Anger. Good._ You're going to need that to trick the words out of him. You've noticed his tendency to insult you intensify when something you say hits home. "I can see you racking your brain when you're not just staring at walls, and maybe you've been thinking whatever it is you keep thinking for a while, maybe even since the surgery, and it's not getting resolved. That much is obvious. And for some reason you don't want to use me as a sounding board like you do with cases. But maybe you _want_ me to know. Maybe you're expecting me to work it out myself, but I can't, Sherlock. And you can believe that it's not for lack of trying." This is mostly guesswork — just the kind of emotional conjecture he ridicules you about, but could Mrs Hudson truly be so wrong?

You lick your lips, leans your palms on the back of your chair for fortification. "Let's change roles for a moment. If you were my patient, what would you deduce?"

"What, pray tell, are my clues, then, for this deduction?"

You swallow. "Insomnia. Nightmares. Depression. Refusal to stop being on sick leave."

"I'm not a doctor," he dismisses, rearranging the duvet onto his lap.

"No, most of the time you think you're smarter than any of us. Most of the time you _are_ , but not when it comes to looking after yourself."

"You sound like Mycroft."

"Who's not here. While _I_ am." Sherlock's brother has been of no use with his faux-soothing declarations of Sherlock just needing time. You haven't contacted him lately. Let him believe everything is fine for all the help he's been.

"For how long?" he demands. "Your physician's oath might have made you stick around for this long, but what if––"

 _We're getting there_. Your fingers dig into the back of the chair. "I don't stick around out of obligation. I stick around because I quite like being here. With you. And I just want to understand." You know you should try to avoid saying that you just want things to get back to normal, because that might put pressure on him. Might make him feel guilty for being the reason things aren't fine.

It's not his fault. He's just reacting to something he can't resolve with his massive intellect.

"I keep trying to inventory everything. Test all the systems, but I can't be sure," he says, delicate fingers trailing down his cheeks from where his fingertips had momentarily perched on his temples. "I can't know it's all there. Not until we get back to the Work. But if it's not… I don't… I don't really want to see the evidence. I can't look, but I can't _not_ look."

"What do you mean, _if it's not all there_? What's not there?"

"How do they know what happens when a heart stops, John? When it's _stopped_? How do you prevent cell death in the brain — the kind of subtle destruction some average mind wouldn't pick up on? Cell death in numbers that wouldn't matter to an idiot, but what _would_ matter to me?"

The word _average_ is the first word you've heard from him since the hospital that sounds perfectly like the Sherlock of before — spiteful and proud.

It makes sense, now. He worries that what sets him apart from others, he's lost. He worries he'll be like everyone else, with his brilliance no longer birthing the shadows in which he hides what he sees as his many flaws. He thinks you're here for just that, not him. And you doubt you could make him believe it when he's this worried about having lost his most prized abilities.

What you can offer him is _information_. "I get that it's a disturbing thought, but they start the bypass before they even do that. Before they administer the cardioplegia." You try to avoid dramatic, laden language, try to dress his fears in a protective coat of science, of medical fact and plain data. "It's pretty smooth, that transition. They don't flip an off switch and then reboot."

"The bypass promotes blood clotting. What if there are significant amounts of blocked microcirculation––"

"They gave you heparin for that stage. That means your blood doesn't really clot much." You turn the chair so it's facing the sofa and take a seat.

"What about microscopic bleeds, then, in the brain? And what about the defibrillation?"

"What about it?" You lean forward in your seat, palms on your knees. Your heart is pounding, your shoulders heavy with the knowledge of the importance of this conversation.

"Does it not produce asystole?"

"For a second or two. Anyone might have a pause that long after even just an extra beat when they're asleep."

This seems to make him introspective again, cocooned in the grey linens of his duvet. "I shouldn't dwell on it. As you told me, there wasn't much of a decision to be made. Submit — or die."

"It went as well as it could have. You were in such fulminant dysfunction that it was unlikely that you'd just bounce back from the bypass. You nearly still did that, bounce back. A bit of AFib is far from the worst that could have happened."

"I can't remember much. Fragments, words. All I have is what you can tell me."

 _Then why hasn't he asked_ , you wonder. Is it because he fears the answers? "I know that bothers you. Do you want me to tell you about what happened before you got coherent?"

"Won't change the outcome."

"Might help you make sense of things."

"Mycroft thinks I shouldn't act surprised — that I just got my due."

"He's an idiot," you say firmly. "It's like a death in the family, medical emergencies like this. Even if you knew to expect it, it still hits you hard. You barely had time to understand that you got ill. Anyone would be reeling from that alone. You had to sign up for massive surgery very suddenly. It takes a while to process it."

"And there's nothing to facilitate that except time?" he asks, incredulous and defeated. "I don't _want_ to keep thinking about it, but it's all I can manage. They never explained about the recovery. I didn't know what to expect. If I was lucky, I was going to _not die_ , but what else? They gave me no guarantees of anything. I should have asked more questions, but most likely I would have still chosen to go through with it."

"You're still allowed to worry about the cost and be disappointed that it was harder than you thought."

"I didn't have _any_ time to think!" he snaps.

Nobody explained to you, either, what it would be like when the nerve bundle in your shoulder got fucked and you nearly exsanguinated from a nicked axillary artery. You could have extrapolated, from your medical knowledge, from your surgical experience, what it would be like right after. You'd seen the pain, the confusion from the pain meds, and you'd seen the colour returning after red blood cell transfusions, but you didn't know how a person feels and should act when they're sent home, discharged from their career. You didn't have any time to think, either; you were too busy hoping you wouldn't bleed out on that sand bank or that another bullet wouldn't hit you or whoever might come to your aid.

Here you finally have the reason for the denial — Sherlock fears going through with rehab and the rest of his recovery, because he fears it'll bring him face to face with what permanent consequences might be left after he's done his best to get back to normal. His physical infirmity remains severe, and there's a long way to go, but he's healthy, fit — at least once he starts sleeping again — and there's no reason why he couldn't achieve a very high fitness level with the new valve. But all that would be a lot even if he wasn't worried about microscopic clots and bleeds in his brain, of brain cells blinking out like white dwarf stars in the cosmos of his genius.

You can't make promises for him that none of those fears, none of that defeat in the face of such an uphill climb is uncalled for because he'd just dismiss your reassurances as the working of an inferior mind. There is one thing you can tell him, however, because you're his friend and a doctor and _his_ doctor and his _person_.

What you can tell him is that depression is common after major surgery — cardiac surgery above all — and that it can mimic cognitive impairment, especially in someone whose massive intellect rivals anyone in any room, ever. You _do_ tell him this, and you can't read on his features whether it helps, but in your own ears it hadn't sounded dismissive or pretentiously optimistic. "I know you're shite at patience," you add, "but it's early days yet. I promise to tell you if you seem to have gone daft, eh?"

The humour slips off like water receding from a beach at low tide and seems to make no impact. Silence makes it fade, turns amusing into embarrassing.

"There are lots of surgical videos online. Maybe we could watch one of those valve operations; I could explain the different stages and you can see for yourself. Reality tends to be a lot less weird and graphic than what people imagine," you offer.

"Perhaps."

He doesn't sound keen at all. Usually, facts are what he craves the most to solve mysteries; he approaches even emotional problems like mathematical equations. If he finds the right bits of information and orders them correctly, he thinks he'll have the answer. _It's different_ , you remind yourself, _sifting through forensic evidence when it's you on the slab_. Would you have wanted to see a video of your shoulder being repaired? You're not sure. Maybe you're making this suggestion too early, or maybe it's off the mark.

Finally, Sherlock speaks again. "My intellect is all I've ever had. Without it, what have I got to offer?"

 _Offer to whom?_ you wonder, stupidly, because he's looking right at you now, and there is something pleading in his gaze.

It's not just himself he fears losing. It's you, and it's a reflection of the horror of what you barely kept at bay when he underwent the operation. You don't want to lose him — any version, form, or part of him. _Doesn't he know that_? you wonder. _Doesn't he know how important he is?_

Sherlock sees, but he doesn't observe. Sex doesn't alarm him, but perhaps the kind of love that has bloomed between you does because it is as subtle as it is relentless. He has these fears because you matter, you realise. And it took a near-death experience for you to stop fearing the monumentality of that truth. Of what you've grown to mean to each other.

Does he not know?

Does he not know how you drowned in him long ago, and those women you half-heartedly dated were just idle, token kicks towards a surface you no longer missed. You slipped into this life with him as though it had been your own for a long time, and you didn't even notice your perspective shifting from what you thought you wanted to what you now realise you have.

"It's always you. Still you," you say, and his oddly coloured irises are fixed intensely on you now. "I'm not staying because of the Work, and I'm not staying because I've got nowhere else to be yet," you say. It's just as well that you'd said _I love you_ , and it's so odd how the coldness in your stomach which seeing him in pain has created has swallowed your doubt and your anxiety over accepting what he is to you.

He's more important than your hesitation, more important than your habitual girlfriends and the things and words you thought would always define you.

"I'm not very good company these days," he says dismissively, but you know him well enough to spot the apprehension and curiosity in his tone. He wants you to make your case, to justify your opinion. He wants you to overrule his brittle confidence when it comes to others wanting his company.

"I don't know what this is," you say, your hand indicating an invisible connection between the two of you. "But it's… us. You don't have to worry about me leaving."

He nods. "You don't have to worry about being asked to leave."

If you never speak more of this, if never put it to words more bluntly, it won't matter. You're tired of cliché and normal. You're tired of courtship and expectations and lying tangled up crumpled sheets next to the sleeping form of a woman pretending that the experience is better than the disappointing reality you try to push away. You're tired of existing somewhere between, of having one foot in a life you always found bland and one here, where you belong. You're tired of everything but Sherlock.

So you go to him, sit next to him, and pull his form against you. He's a mound of bones wrapped in a duvet of Egyptian cotton, which has probably cost more than a surgeon's monthly salary. You wrap his arms around you, and he fits there like no one has ever fit, and you can't even fathom how you once wouldn't accept the fierce protectiveness you feel for what it is: love.

"All things considered; I do feel better now than I did the day we caught Marston," Sherlock says. "Objectively. Physically."

"You mean when _I_ caught him?" you joke, relieved.

Relieved that he sounds calmed and doesn't seem bewildered by the sudden intimacy. Relieved that he finally sounds like he's talking about the future instead of trying to make sense of the past.

On his features you see a shadow of the smirks he reserves just for you, but it's something. It's a start. He's not cast adrift, but there is someone on the shore, holding the rope just so that he can be pulled back to safety.

They fixed the cords keeping his valve together. Now, you'll start fixing the tethers which will reconnect him to his life.


	15. The Return of The World's Only Consulting Detective?

The change is subtle, but it's there.

The next PT candidate stays, and their advice is not just listened to but heeded.

Perhaps less subtle a change is how you no longer climb the stairs up to your bedroom. Your _old_ bedroom, as Sherlock calls it now. He has plans for it, you see. Plans which do involve filling the space up with chemistry equipment and which most decidedly don't involve you sleeping anywhere but by his side, where you belong.

This is how he phrased it one night: _'I would hope that you also feel that it's unnecessary to continue being together during the day and then being apart during the night'_. He made a polite inquiry of it, standing by the fireplace, wringing his hands behind his back. He'd put on his proper clothes that day; no more ratty pyjamas and dressing gowns. He'd not left the flat yet; the stairs were a bit much for him, but he put on his clothes and looked like half of him expected to be praised for his cleverness and half to be rapped on the knuckles as he awaited your response.

You didn't stand up and cross the expanse of the floor to kiss him. That day will come, but it wasn't time for that yet. This is you and this is Sherlock, and steps need to be taken in the right order so that he can savour them, categorise them, understand them and make sense of them in a way that he can weave into the rest of his existence. He needs you to understand that — a step into a relationship for him is as momentous and earth-shattering as the shaking of the core of your sexual orientation was for you, which he brought forth.

At night, in bed, you hold his hand, and him. There is no falling in love with Sherlock Holmes, not for you — there is only falling deeper into what you tried to swim against, helpless and exhausted to fight since you knew somewhere inside where you'd end up. Right here, in his arms, and he in yours.

You will kiss him yet. You will do all those things which separate friends from lovers, and you will savour like you've never savoured them before, because seeing him experience all of them for the first time will make you feel as though you are, too.

_____________

Three weeks later, Sherlock's physical recovery has begun in earnest. Once he could extend his walks beyond eight kilometres with ease, he began running under the direction of his PT. Not even this has provoked forth another episode atrial fibrillation; Mike is convinced that those had just been a phenomenon associated with cardiac dysfunction and a very recent valve repair. Sherlock has built so much fitness, perhaps even beyond his pre-valve problem level, that you wouldn't even try to compete with him. Then again, you never could, the lanky athletic git he is. To your great relief, Sherlock is also eating much more since the exercise requires calories. Mostly what he's gained is muscle mass; there doesn't seem to be many ounces of fat lining his figure. You have no complaints on that front; you could get drunk with desire watching him undress. Could, but will hold back for some time more. You know that day will come, and this certainty allows you to summon the patience you need. He spoke of this one night, saying he wants to meet you halfway, not struggle to keep up. It's not time yet. He wants you, but he wants to make love only when he can do so feeling like himself again.

And there is still one thing standing in the way.

His physical recovery might be going well, but the matter which he'd revealed to you that one night when he finally trusted you with his worries. You have alleviated much of his dread of being rejected but you know, instinctively, that the core of those fears remains: not knowing whether the surgery has left him damaged, somehow. This is what keeps him from returning to the Work, and no neurologist or psychologist could put the issue to rest. As Sherlock had commented, tests designed for any and all patients are tests best suited for people who are most decidedly not like him. An utterly unsuitable for measuring the kinds of changes he's worried about. _'It would be like trying to measure an atom with a tape measure',_ he complained when you asked if he was going to schedule the neuropsychologist appointment Mike had suggested when you'd asked for advice by email. You took that answer as the longer version of his _nope_ with that uppity, popped _p_ you secretly love because it's so him.

How do you prove to the cleverest man in England that he's still got it, then? The answer comes to you one night when listening to Sherlock shouting at the telly: you do it by recruiting his only rival for that title.

You hardly need to convince Mycroft that something needs to be done; he's gauged from some strategic text messages designed to provoke certain responses and from the fact that Sherlock has not contacted Lestrade yet about cases, that something is amiss.

Over tea in the library of his Chelsea apartment, you and the older Holmes agree that physically, Sherlock is doing tremendously better. What worries the both of you is that there are still no cases. That, and the fact that he still seems to find it terribly stressful to try to discuss what has happened to him. You have repeatedly suggested watching surgery videos, reading descriptions of what transpired during the operation so that the air of mystery and the conjecture his prone-to-histrionics brain must be cooking up could be exorcised. He worms out of these suggestions not quite by declining outright but by insisting he's busy, or by disappearing outside for a run.

Standing in his home study, visible through the doorway which connects it to the library, Mycroft makes two phone calls.

When he returns to the library, you're on your feet, having read in his expression that a plan has been formulated.

"The details will be forwarded to you by email," he informs you. "The task befalls you to convince him to go through the first part."

"Which is?"

"All the neurological, neuropsychological and cognitive testing that was offered on his last appointment with Doctor Stamford but which he declined upon discharge — performed with some important additions by professionals with particular expertise beyond that found in NHS hospitals."

You didn't know he had been offered such things. You just thought that Mike's reply to your email had been the end of that conversation. Maybe that's why Sherlock had asked you to step out during the latest appointment. You'd felt hurt by that request after everything you'd gone through together, but consoled yourself that it was good that Sherlock was taking charge of his health. Little had you known that you might have just been facilitating his continued denial.

"Who did you just talk to?" you ask Mycroft.

"Someone who routinely makes very detailed assessments for high-performing operatives who frequently sustain head injuries."

Has to be MI6. You always suspected they ran their own specialised covert medical services. These must be the _specialists with expertise beyond what is usually found in the NHS_ or whatever. _Occy health for Bond_ , you chuckle to yourself. _Wouldn't want to be his GP_.

"And part two?" you ask, trying to sober up since Mycroft is looking at you as though you've suddenly developed a bad smell.

"You will leave that to me. I will provide a challenge he cannot decline, if only to prove his superiority."

_____________

"The results will only be given to you. Not even Mycroft will be privy to them," you explain to Sherlock, who's plucking his violin where he's perched on the backrest of his chair. You pity the cushions; furniture doesn't last long in mint condition around Sherlock.

"Why would that make the news more palatable?" he asks dismissively.

"You're assuming the news will be bad."

"I'd rather not know since that is a possibility."

"You can't continue like this, can you? This… half-existence. It's not you."

"Shouldn't you just rejoice that I survived? That's what everyone kept telling me at the hospital."

"I'm not everyone," you say sternly. "I _know_ you. I know how much this means to you." _And how scared you must be still_. "I know why it's a matter of life and… as good as being dead inside." You don't mince your words around him. You respect him too much to resort to empty platitudes.

You need to meet this head-on, together, but he doesn't seem quite convinced that you can weather such a storm with him. That anyone could. "Not seeking the answers doesn't change how things are. As much as you'd like to be Schrodinger's genius, wouldn't you rather skip years of not knowing, of worrying — most likely needlessly?"

"What are you proposing, then?"

"The appointments have been made. All you need to do is show up. Mycroft promised that your intelligence won't be insulted by anything pedestrian. They'll test different kinds of memory, executive function, processing speed, multitasking, functions requiring multiple centres of the brain simultaneously, planning and executionary processing… There's also an EEG and a functional MRI to be done while you solve complex problems."

"Is that all?"

"No, that's not all, but it's the first step."

"How can you make a comparison when there is no baseline to these tests? All you have is me, now. Nobody knows what I was like before."

"They will compare what they see to the results of several high-functioning, high-performing individuals."

Mycroft had said that the results would also take into account Sherlock being on the autism Spectrum. You omit mentioning this and doubt that Sherlock would ask about it. He'll probably just assume it won't get factored in and that such an oversight will skew the results.

"I suppose MI6 people are at least marginally less incompetent than most of your profession," Sherlock dismisses.

There's another thing you want to bring up — something you told him once, but it bears repeating. It's still not easy to say the words.

You clear your throat, lean forward in your chair. "You know there are things which can cause temporarily lowered cognitive performance even though they are treatable and have nothing to do with your surgery."

"Such as?"

"Depression. PTSD. Other anxiety and mood disorders. None of which will get better by sticking one's head in the sand."

You've armed yourself with data a bit like Sherlock conceals his insecurities and fears in factual information, and you push on. "Up to one in eight heart attack survivors develop PTSD. Stress-related anxiety, sleeping problems and mood issues on a smaller scale are dead common, Sherlock. You needed emergency surgery for heart failure — plenty bad enough that you'd still be affected."

He rises from his chair without a word, goes to his bedroom and slams the door.

You harden your heart against the longing to go after him, to wipe away the impact of your words. _'He won't take them well,_ ', Mycroft had warned you, ' _but coming from you, he just might accept them because he cannot dismiss you as easily as he can others._ '

You can't concentrate on the telly all night because you can feel the distress emanating from the other room. You need to let him think, but it's hard to see the pain he's been in this whole time escalate because you've taken away its escape hatch.

At eleven in the evening, the door opens. You don't turn to look at him, because you don't want to make a fuss.

"Tomorrow at nine fifteen," he tells you. "Vauxhall Cross."  
  


______________

  
  


  
When Mycroft returns to his office in one of the basement floors of the intelligence service headquarters, Sherlock springs to his feet like a defendant in court. His brother's expression betrays nothing; hardly surprising in his line of work.

Mycroft directs his explanation at you first; you've sat waiting in this room for most of the day while Sherlock was being sent to talk to various people.

"What I presented Sherlock with after the biomedical wing had their fun was a cluster of real-life intelligence problems which took our renowned, world-class analyst department of twelve individuals all highly trained and talented in their fields eleven days to solve in its entirety. Regrettably, I was… abroad on another task at the time of the appearance of that data. Once I returned from those travels, I took it upon myself as an intellectual exercise to see how long it would have taken me to resolve those puzzles, if such an expression is permitted. What was required was the rapid acquisition of novel language skills, advanced code-breaking, the deciphering of complex geomorphological data from various sources and some rather complicated ballistic physics combined with knowledge of explosives. Those, of course, Sherlock is more familiar with than I, but my language skills far exceed his."

"How long did it take you, then, to solve those things?" you ask, wondering why Sherlock is already looking a bit like the cat that ate the canary. He must be able to read something in Mycroft's typically snide expression that you can't.

"Eight hours and twelve minutes. _Brother mine_ did it in nine and forty minutes."

"Damn!" Sherlock curses as his face falls — but only a bit. His expression is odd: while looking genuinely furiously frustrated that he'd been bested by his brother, there is what you could only describe as relief there.

"Well," you start placating him, "Mycroft's career is in intelligence. He's got more practice at this sort of thing."

"He likes to think what he does requires outstanding intelligence. Occasionally, it might jog things along, but mostly he just pushes around foreign dictators."

"I am merely guaranteeing that the Commonwealth can sleep easy," the senior spook comments dryly, then pours himself a glass of water. "In case you are interested in the rest of the results: all normal — for the likes of us, I should add."

"Is it enough?" you ask. _Is it enough to convince you that you've still got it?_

Sherlock looks satisfied, but can you be sure that a test devised by his brother whose profession it was based on will convince him?

"Admittedly, many aspects of what I've just done _were_ analogous to the Work, and having an acceptable reference person and knowledge that a group of above-average minds took _days_ to get through it…" He nods. "Acceptable."

You can't help grinning, then flashing that triumphant smile in Mycroft's direction as well. Who better to prove Sherlock's still got it than the man who also has… well… _it_. The deduction thing.

"I think this calls for cake," Mycroft declares.

You couldn't agree more.

"I knew you were going to say that," Sherlock declares.

"And I predicted you'd be amenable," Mycroft replies dryly and grabs his coat.

**— The End —  
  
  
  
**

**Notes for the Chapter:**

> I knew the fandom enjoyed a bit of medical H&C, but I didn't quite expect how much it _craved_ this sort of thing. I must thank you all for the enthusiasm, for the shared feels and the lovely commentary.


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